The Health | december , 2020
| Column |
Monitoring patients remotely during Covid-19 can be beneficial for both patient and the healthcare provider
Movie buffs may be familiar with
a scene from Jurassic World where armed private security guards in the deep forbidden ancient jungle looking for a hybrid dinosaur . The guards ’ vital signs like pulse rate and respiration rate being monitored at a command centre .
One by one the guard ’ s life signals are obliterated on monitor screen as the freak creature went on a rampage . Or the John Stratham ’ s movie , The Meg , where oceanographers travelling in a submersible in the darkest depth of the ocean whose vital signs are being monitored . They are being terrorized by giant sharks wherever they go .
Closer to home and less cutting edge , a doctor in the clinic is remotely monitoring the blood sugar of a diabetic patient at her home . Another doctor in a clinic is checking on the pulse rate of a patient with hypertension at his home .
Remote Patient Monitoring ( RPM ) should become a triage engine of digital healthcare especially during the Covid-19 pandemic . RPM is a subset of telehealth having its prominent place for variety of reasons since the pandemic started .
In telehealth , it is about all healthcare activities that are conducted through telecommunications technology . Remote patient monitoring entails the collection , transmission , evaluation , and communication of patient health data from electronic devices . These devices comprise implanted equipment , wearables and handheld instruments .
We can define remote patient monitoring as a set of activities that fulfills four key criteria : ( 1 ) patients data is collected remotely ( say , in a home setting without being attended to by a health care provider ); ( 2 ) the data collected is sent online to a health care provider in another location ; ( 3 ) the data is evaluated and notifications done to health care providers , should the need arise ; and ( 4 ) care providers communicate results and possible interventions to patients .
There are several health care portals that offer telehealth but while virtual visits can be beneficial for both patient and the healthcare provider , it will be more significant if the virtual visit were to be incorporated with RPM and checking done real time .
The benefits of RPM during the Covid-19
BY ZULKIFLI AHMAD
Remote Patient Monitoring ( RPM ) should become a triage engine of digital healthcare especially during the Covid-19 pandemic . RPM is a subset of telehealth having its prominent place for variety of reasons since the pandemic started .”
pandemic are many such as :
• Reduced use of Personal Protective Equipment ( PPE ). Other than the costs involved and supply shortage , exposure is most likely one of the largest concerns right now at hospitals .
• Less staff for more patients where a monitoring personnel can deal with hundreds or even thousands of patients .
• Free up treatment and beds for Covid-19 patients when those not infected with chronic diseases are remotely monitored . Even those with mild Covid-19 can safely be monitored at home
• Increased patient to physician communication as compared to conventional in-person visits .
• Patients are more involved / knowledgeable about their health and care when in constant communication and with regular information feeds
• Home systems mean less hospital visits and less chance for spread or getting infected when people with or without Covid-19 congregate at hospitals
• Protect frontliners as in-person interaction is reduced .
• Mental health of frontliners can be dealt with through mHealth and possibly help curtail frontliners burnout . This will be further explained later .
Trouble shooting and possible cutting down on teething problems
These guidelines are drawn from the experience of practitioners managing RPM programs who related their findings to Harvard Business Review which was well documented well for those undertaking RPM . Easy and practical use of technology Both patients and clinicians must find it easy to use and adopt the technology with data simple to monitor and analyze . Seamless blending into clinician workflow In some cases , the processes need to be redesigned for remote monitoring to be integrated into an organization ’ s procedure , the interoperability aspect to be considered . Allocate enough non-physician staff to carry out programmes Physicians are not always required to handle some cases in the program but yet complex tasks involving , say hypertensionmedication management still might r equire a nurse or pharmacist instead of a patient navigator without clinical knowhow . This again will reduce burnout among physicians . Digital health equity During the pandemic and beyond , care providers should endeavour to ensure underserved and less privilged patients not only have access to remote monitoring programmes but are also given education and support to make them successful . Infrastructure advancement Surely remote monitoring cannot be on baby monitor or nanny cam bandwidth to operate . Wider connectivity and scalability of bandwith and advent of 5G will be of great help Start with pilots Start first with small programes and then scale up gradually to avoid making expensive mistakes
It is ESG 2020 ’ s hope on the following : Bundling of sustainable funds and acts / policies Stakeholders get their thoughts together to open the path for RPM to be a norm and triage engine in healthcare during the pandemic and beyond through initiatives involving getting sustainable funds and cobbling together various Acts and federal policies . Address burnout among frontliners In 2019 , during pre-Covid-19 , the Malaysian Medical Association ( MMA ) warned that staff are overstretching themselves to meet higher demand in hospitals . The situation is now exacerbated with the onset of the pandemic .
It is fine we talk about cutting edge and disruptive technologies to facilitate healthcare during the pandemic . Burnout , however , especially among physicians , is a serious matter that needs addressing . What is the point of technology when there is no one to help make it function efficiently ?
Burnout is not only seen as exhaustion from overwork but other factors . There is such a thing as burnout arising from physicians trying to reconcile between traditional medical diagnosis and the invasion of disruptive technologies . In sociology , job alienation is about a worker feeling estranged from his work , finding it uninteresting .
In the medical world , burnout suggests that the physician feels depressed , dissatisfied and a sense of failure which affects him or her greatly and also patient care . Being constantly in front of the computer is among the complaints of the causes , so we do not want RPM to be an additional mainstay in the good doctor ’ s problems . This is where capable non-physician staff play a great role . Initiate a program using existing and watered-down technology for RPM University Malaya has applied remotely via mobile application and phone calls , the protocol for Psychological First Aid ( PFA ) with guidelines in dealing with Covid-19 infected frontline healthcare workers and also those with possible burnout . This pilot remote PFA protocol may be deemed as a platform for further research on the application of an Agile goal-oriented approach in a healthcare organization .
Covid-19 has created the window to speed up the adoption of RPM as our healthcare system is making all efforts to care for patients outside of walls of a clinic or hospital . Leaders with stakeholders will do well to be encouraged to act decisively in establishing new programmes by following best practices and guidelines .
This is to further ensure patient care is efficiently delivered that goes far beyond the current scourge of a crisis . — The Health
Zulkifli Ahmad is the founder of Sustainability ESG 2020 , a think-tank advocating ideas and actions on sustainability .