By Denise M Sorrentino, Physician and COO, Iowa Heart Center/MercyOne
Medicine is famous for acronyms and abbreviations of much longer diagnoses or tests. Within the last few years, a new acronym has surfaced –RPM. At first, this caused confusion among providers as RPM typically stood for ‘revolutions per minute’ – an abbreviation for power in a motor vehicle or bicycle. Alas, we have a new medical acronym for RPM–remote patient monitoring.
In a way, this abbreviation of RPM (remote patient monitoring) could also be a reference to “power.” An enhanced form of power the patient and physician have when there is a massive increase of information accumulated in the thousands of hours outside the physician’s office.
The power of RPM
From the very beginning of the doctor-patient relationship, diagnosis and treatment have been decided upon by limited points on a chart. Often, the values collected during a single office visit can be misleading or inadequate. Yet, we have accepted this limited data set as a place to begin medication, recommended testing and treatment plans. There have been multiple instances where patients have protested that their blood pressure is never usually that high. Although their pulse rate is normal now, it was irregular and erratic during the car ride to the office visit.
Enter technology – Enter ‘wearables’ – Enter RPM.
Remote patient monitoring has and will continue to revolutionize patient care and improve patients’ understanding of their role and contribution to their healthy lifestyle plan.
The ins & outs of different RPM models
Remote patient monitoring is available in multiple models and forms for nearly every age member of the population. RPM will likely be key in elevating health care to the successful “prevent and address” problem-solving system it should be.
Kit plus website
One common RPM model is the “kit plus website.” This could include a blood pressure cuff, scale, pulse oximeter and a brief daily questionnaire. Using this model, the patient weighs daily, checks blood pressure and heart rate, and answers questions on shortness of breath, dizziness and energy — all while at home. Then the physician’s office checks the patient’s data daily and looks for red or yellow alerts. Red and yellow alerts require a call to the patient with recommendations or medication changes.
Similar RPMs are available for blood glucose, daily steps and activity. Physicians often use these to monitor and optimize care for patients with diabetes.
Implantable RPMs
RPM devices also come in the form of implantable devices, like pacemakers and internal cardioverter-defibrillators. There are over 400,000 cardiac devices implanted every year in the United States. In the past, patients had to travel to a clinic to have their pacemaker or defibrillator monitored at least 1-2 times a year. However, over the past ten years, all cardiac device companies have established remote, wireless monitoring to allow cardiologists to follow patients’ devices closely.
The devices send alerts for new arrhythmias which prompt physicians to begin often lifesaving medication changes and blood thinners for stroke prevention. The devices also send alerts for possible lead (wire) fractures or malfunctions. All of this allows prompt intervention and markedly improved patient care.
Finally, with this technology, patients can send a transmission on a day they feel pounding or racing (palpitations). This further helps secure diagnosis as physicians can help patients correlate symptoms with a rhythm recording on their device.
My personal favorite in the RPM arena: wearables
Wearables refers to the massively growing group of technology everyone has access to monitor their bodies and participate in the greatest advancement in medicine — PREVENTION. Wearables include rings, smartwatches, glucose monitors, watch blood pressure cuffs, as well as “portables” such as the small Kardia mobile heart rhythm monitor.
I fully advocate for the utilization of wearables for all adults. Wearables help track activity, step count, hours slept each night (including depth of sleeping), blood glucose levels, especially during intense training or for those in the pre-diabetes state. All this information is transmitted from the wearable device to an app on the owner’s smartphone or computer. The graphics tell the story of what needs to be worked on for better health. Wearables are engaging, informative and for many, very motivating to reach goals.
The future of RPM
The tech and AI community continues to boom with startups aimed at helping us all–physicians, patients, and pre-patients- get the information we need and then advice on how to improve.
One of my very favorites is an RPM platform that not only asks patients to enter data on weight, blood pressure, ankle swelling activity and sleep–but also social interactions. The sad fact is that many people, especially older adults, are at risk for a decline in health due to loneliness. This RPM tracks the number of social interactions daily and then “nudges” the individual to do more if they are at risk for loneliness.
I believe that RPM, in its many forms, is where the revolution in health care will lie. Patient and physician data sharing between in-person visits will truly optimize health care and prevent disease and disaster. Bravo to RPM.
