Healthcare gone remote in COVID-19 era

From a typical brick-and-mortar environment to the application of digital and data technologies to engage patients at a safe distance, the pandemic has facilitated a shift in the delivery of healthcare.

During a panel discussion on remote patient monitoring (RPM), speakers at the APACMed virtual forum spoke of modern digital healthcare solutions, how they have enhanced patient care, and their role in the pandemic response.

“The reason remote monitoring first came about was the movement to try to bring healthcare out of the hospital and into the home, what with hospitals in mature markets being high-cost healthcare settings particularly for chronic disease patients,” according to Justin Leong, president of ResMed’s Asia & Latin America markets.

Aside from costly hospital visits, tracking the patients’ health in their homes through remote monitoring-type equipment certainly has other merits.

For Dr Ravinder Singh Sachdev, deputy chief medical informatics officer at Tan Tock Seng Hospital in Singapore, RPM has somehow transformed the practice of obtaining patient data for the better.

“These days we’ve got dedicated platforms, all-in-one devices, increased array of sensors, and integration of this data with electronic medical documentation—these new processes have been able to make it easier for clinicians to monitor patients, but more importantly, it made it easier for patients to share their information with providers,” Sachdev said.

COVID-19 response

RPM has been around for years, but its uptake has been limited until now. Considering the problems caused by the pandemic—burdened hospitals and the increased risk of exposure to infection during face-to-face appointments—remote or virtual care became an important part of the COVID-19 response, which has been twofold: to deliver nonemergency care and to safely treat and monitor hospitalized patients.

“We’ve seen a huge number of health systems automatically switch to outpatient virtual care settings,” noted Farhana Nakhooda, senior vice president of Healthcare and Life Sciences, Asia Pacific, at Health Catalyst.

As an example, Nakhooda shared the experience of one of their clients from the US. “Virtual care is 80 percent of all their visits, and this was an organization that didn’t even have a telehealth platform before COVID-19. They had to one-up very fast. [Now] they’re getting about 40,000 visits in a month.”

Individuals with chronic diseases, such as young asthmatics, middle-aged diabetics, elderly patients with cardiac failure, are some of the many patient populations who stand to gain most from remote monitoring solutions in the current healthcare climate, according to Sachdev.

“They can contribute data regularly to an RPM platform which clinicians can then look at and use to follow-up … and intervene at the right time. This, in fact, is what gives you that continuity of care, which was previously only episodic,” he explained.

Abishek Shah, CEO of digital solutions company Wellthy Therapeutics, agreed by saying that combination of the digital therapeutic stack working alongside paramedicals and physicians ensures that real-world outcomes are improved.

In a respiratory condition such as asthma, for instance, the combination of a cloud-connected cap on an inhaler, GPS coordinates of a patient because of their mobile phone, geofenced weather/environment data, and a known patient trigger history will “allow you to focus on not just monitoring the patient but really understand a lot more about the environment [that is potentially] causing attacks or triggers,” Shah pointed out.

Moreover, with the help of the prediction algorithms that are already there, the “system can give tips … to improve symptom free days and reduce risk of hospitalization,” he added.

Leong chimed in, saying that the data generated from connected medical devices, when analysed and applied an artificial intelligence (AI) and algorithm, can show trends in the patients’ clinical symptoms and alert doctors early on things that are about to go wrong. It’s not just about treatment compliance anymore, but more about personalizing the therapy (eg, make a change, alter the dose) to achieve the best outcomes possible.

RPM within the hospital can be useful as well, Leong continued. It is not easy for doctors to monitor every patient over time. “But with the ventilator that’s sending data on a regular basis into the hospital system,” the job gets easier.

As a physician himself, Sachdev confirmed that remote monitoring “doesn't necessarily mean that the patient and provider are separated by huge distances, especially [in the case of] COVID-19.

“The application of remote monitoring technology has allowed us to be able to [keep an eye on] many of our patients in isolation, even though they are just maybe 3–5 meters away from us, without putting our clinicians at risk,” he said.

Leapfrogging

Leong identified an opportunity to further expand telehealth in China, where healthcare is centred around the hospital. “There is no home care system, so everything is in the hospital. If you get a cold or a minor illness, you go to the hospital. And if you're a chronic disease patient, you get treated in the hospital.”

But the fact that China is a very entrepreneurial place and highly adoptive of digital technology, he noted that already, quite a number of digital health companies have started providing “Internet hospitals,” which are basically telehealth.

“Helping the government digitize the hospital system is the next evolution of digital health in China and could be really powerful as the hospital system suddenly becomes modernized… I think that's probably the major sort of public private partnership that will happen over the next decade,” Leong said.

In addition to the coming together of the healthcare ecosystem, Nakhooda believes that the future will move toward a more value driven perspective on care.

“[We are] finding ways and opportunities to shift to risk-based payment models, to incentivize the use of telehealth, especially for chronic patients,” she said. “Ultimately when payers and providers come together, no matter how tricky,” the biggest winner will be the patient.

Meanwhile, in India, lots of interesting things are going on, especially in digital health. Shah noted that the country has set its sights on delivering universal healthcare coverage, building a digital health facility registry and e-pharmacy, among others. And this is going to play an important role in reducing the burden of noncommunicable diseases and improving access to care.

In Sachdev’s view, a three-way partnership between patients, provider, and AI is needed to truly take a care delivery to the next level. 

“We need robust AI-driven analytics to give us more feedback so we understand, ‘is this a glitch’ or ‘is this actually an abnormality,’ and then that data is synthesized and sent appropriately to the provider to actually manage their patients better,” he said.

In closing, session moderator Siddharta Bhattacharya, secretary general of NATHEALTH - Healthcare Federation of India, said that all the insights have really been a crystal gaze into the future.

“Many countries have toyed around with digital system, which is a physical and digital system together, but digital actually may open up entirely new care pathways, possibilities which are very exciting. And what we're going through, there may actually be a silver lining out of this,” Bhattacharya stated.