July 7, 2020
Remote patient monitoring empowers clinicians with digital tools to watch over their patients and provide the best possible care whenever and wherever it’s needed.
It can have a huge impact on a patient’s quality of life by helping them to maintain independence and minimise health complications.
RPM can also deliver huge benefits to the health system. It frees up space in hospitals, gives doctors greater visibility of patient progress, allows for nurse-led care where appropriate and improves patient engagement.
Older New Zealanders have a greater dependence on our health system than any other group. So you might think that RPM would be made easy for them to use. You’d be wrong.
If remote patient monitoring was more accessible, seniors could benefit in a number of ways:
The problem is that many older people don’t feel confident using technology, reducing compliance with many RPM systems. Bear in mind that 50% of people over the age of 85 in New Zealand and 25% of people aged 75-84 years have never been online.
Call me old fashioned but shouldn’t healthcare systems be designed to deliver the greatest good to the greatest number? That seems like a fundamental principle of public health policy, yet somehow we’ve ended up with remote patient monitoring systems that disadvantage or in some cases completely exclude older people who are by far the largest users of the public health system.
Imagine if the SuperGold card was only available to people who had smartphones. You had to click a link from a text message and register on a website using a Facebook account. And the only way to claim discounts on travel was to take a photograph of a QR code when you boarded. That system would exclude a large number of people for whom the discount was designed, but I digress.
The main point is we shouldn’t deprive some vulnerable people of a basic health advantage because they don’t have a smartphone or are unfamiliar with the internet.
Compliance with RPM systems for older New Zealanders is highly dependent on the usability of the system. To make it easy for older patients you need an all-in-one system that can be delivered with everything set up in advance. Like a piano. You don’t have to set up a piano. It just gets delivered; then you sit down and play. It doesn’t matter if you are 5 years old or 95 years old.
In the world of remote patient monitoring this means delivering:
Patient compliance is essential. Any RPM system is rendered completely pointless if it isn’t used (or can’t be used) by the people that need to use it. Simplifying the technology for seniors could deliver huge benefits for the health system.
DHBs could save a lot of money by offering age-friendly RPM to suitable older patients, many of whom suffer from chronic diseases and are at high-risk of readmission.
With an age-friendly RPM system, DHBs could increase participation in home monitoring programs and significantly improve compliance with those programs. This could lead to improved outcomes for thousands of patients annually and decrease outpatient appointments.
GP’s could also create their own patient monitoring programs led by practice nurses. This would reduce pressure on doctors time with more appointments for seniors being handled remotely. Early intervention from primary health clinicians coupled with careful self-management from patients could further improve outcomes and reduce pressure on hospitals at a critical time for our health system.
Evidence from around the world and here in New Zealand supports the notion that patients love the RPM model of care. A review of RPM by Waitemata DHB found that:
More evidence needs to be gathered about uptake of RPM among New Zealand’s seniors and what can be done to improve it.
If it is agreed that remote patient monitoring is beneficial to the health system, it would seem logical to promote the use of RPM among seniors (the largest users of the health system) by providing them with age-friendly technology to manage their health.