Remote patient monitoring, part 2: Operational models

In a previous post, I discussed some generalities of remote patient monitoring (RPM). The current value of the RPM market is estimated at $10.6 billion. There are diverse clinical and non-clinical environments in which RPM might be used.

The healthcare ecosystem is becoming a continuum of care, rather than one of discrete silos of acute care and various post-acute care settings, and all parties involved must interact with each other to create better outcomes and prevent hospital readmissions. These are the motives for the institution of RPM along this continuum. There are different models of deployment of RPM that affect investment by providers, return on investment of the process, and logistics and workflows, which I will discuss here.

1. Monitoring performed primarily by the individual. This would include glucometers, blood pressure recordings, weight scales and other accessories to smartphones or computers that, via wireless communication, transmit and store measured data points. The patient can present the data to a healthcare provider or have it sent electronically. This allows for the direct flow of data from the patient to the provider. There is little investment from a financial perspective in this model.

2. Monitoring by the vendor. In this model, the technology vendor provides technical data support and acts as an intermediary between the patient and provider. This was the original model adopted for RPM involving implantable cardiac rhythm devices. This type of model might involve partnering the monitoring company with a wireless provider, such as that between Intuitive Health and AT&T. The cost of monitoring in this model is built into the cost of the technology if used with Medicare reimbursement because of safe harbor law restrictions.

3. Monitoring by a local healthcare system. A local healthcare system might perform its own monitoring. In this model, non-healthcare providers might take directions from physicians who set alerts and algorithms to treat patients based on data received, if necessary. This logistical model also facilitates integration with the patient's EHR. Patients can also call in and discuss related symptoms with providers and appropriate follow-up appointments are made if necessary.

4. Centralized healthcare system monitoring. In some countries in Europe, large academic institutions are performing RPM regionally for smaller hospitals and unaffiliated healthcare providers. They are equipped to handle 24/7 coverage as well as possibly the clinical expertise (as seen with implantable cardiac devices, for example) not otherwise available.

5. Other third-party commercial monitoring centers. A growing number of companies are performing RPM. Some offer physician expertise (professional component) as well as the technical component of monitoring. These companies might have an advantage of 24/7 coverage over small hospital-based monitoring centers.

There are advantages and drawbacks of all the above-mentioned models, and there might be others not discussed. The lack of reimbursement for RPM might slow adoption; however, the most significant impetus for the recent uptake in use has been the hospital readmission penalty policy. It remains to be seen which operational and business models fair economically better than others and, more importantly, which produce better short- and long-term patient outcomes.

David Lee Scher is a former cardiac electrophysiologist and is an independent consultant and owner/director at DLS Healthcare Consulting, LLC, concentrating in advising digital health companies and their partnering institutions, providers and businesses. A pioneer adopter of remote cardiac monitoring, he lectures worldwide promoting the benefits of digital health technologies. Twitter: @dlschermd, He also blogs at He was cited as one of the 10 cardiologists to follow on Twitter and one of the top 10 blogs on healthcare technology.