Speaker: Remote patient monitoring is ‘part of our future’
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LOUISVILLE, Ky. — Remote patient monitoring for allergy and asthma treatment is here and will only grow in the future, according to a presentation at the American College of Allergy, Asthma & Immunology Annual Scientific Meeting.
“A couple of years ago, you sort of had to be a mad scientist if you were thinking about remote patient monitoring,” Travis A. Miller, MD, FACAAI, vice chair of the ACAAI Advocacy Council and medical director and CEO of The Allergy Station, said during his presentation. “That’s probably not the case today.”
Today’s usage
In November 2021, ACAAI and AMA partnered to survey clinicians about their use of telemedicine, including 136 providers who identified as allergists.
Of the 107 respondents who answered questions on sex and race/ethnicity, 58% were men and 57% were white, with most aged 41 to 50 years (27%), 51 to 64 years (25%) or 65 years and older (25%). A majority hailed from suburban offices (61%) with single-specialty offices (52%).
When asked how they were using telehealth, 83% of 116 respondents said they were using it for treatment or therapy; 78% reported using it for screenings, assessments or diagnosis; and 76% indicated they used it for follow-up care, such as post-surgical or chronic care.
“Continuous monitoring came in at 58%, which I think is really valuable, because we were already beginning to see glimmers that remote patient monitoring and continuous monitoring was going to be part of our future,” Miller said.
Platforms used by 114 respondents included Doxy.me (38%), audio-only telephone visits (33%), Doximity video (32%), Zoom (25%), electronic health record telehealth modules or tools (20%), FaceTime (13%), telehealth vendors (12%) and patient portals (10%).
However, only 1% said they used specific remote patient monitoring tools. Also, 54% said that these technologies did not directly integrate with their EHR systems.
“That’s a problem that we need to work on,” Miller said. “But 30% of us say yes, and 11% of us sometimes. That’s an important minority of practitioners who are showing a glimmer of hope we can push these companies to give us better software and support and be able to drive this into our EHR, which is where we want it.”
Technologies used to augment telehealth services included smart phone cameras (44%), smart phone audio (14%), thermometers (13%), pulse oximeters (12%) and home spirometers (10%).
However, 82% of 60 respondents said that these devices do not automatically transmit data to the clinician, which Miller called an area for improvement.
“This is giving us a real nice view of where we’re going in the future,” Miller said. “I’m going to encourage you that you shouldn’t be scared.”
Barriers to adoption
Access to technology and digital literacy are significant barriers to remote monitoring among patients, Miller reported, as well as preferences for in-person visits. Among providers, lack of insurance and uncertainty surrounding payor reimbursement are key obstacles.
According to the ACAAI Telehealth and Technology Task Force, allergists hope to have value-based data showing outcome research in telehealth and technology and a “return on health” platform.
“That word, ‘value-based,’ I think we’re going to see more and more in the future,” Miller said.
Also, given that a majority of survey respondents said they were not aware of any telehealth research or best practices, there is a need for better dissemination of resources and information, Miller said.
Yet patients do want to engage with “disruptive innovation,” which Miller described as simple, convenient and affordable solutions that drive emerging technological innovations.
“Time is at a premium for patients and providers. We’re in the rush culture. Our patients are impatient. They want it now,” Miller said. “This really drives our reliance upon telemedicine, so we’re just going to have to accept that as part of our future.”
The COVID-19 pandemic was a key driver in this shift to telemedicine, supported by government funding with a focus on the consumer experience as well as by innovations in artificial intelligence and smart devices, Miller said.
In a May 2021 poll about physician attitudes toward digital technology, Miller said, 14% said they prefer being the first to pilot it, 26% said they generally adopt new technology before others do, 34% wait for data before adopting it and 25% called themselves slow to adopt new technology.
“It’s a fairly bell-shaped curve. That means it’s not too late. But I would encourage you to get some information today,” Miller said.
Tools in practice
MIR and Aluna produce home spirometers that provide flow volume, longitudinal assessments and other data via mobile apps that connect with the practice’s EHR. Miller said that his office, which began monitoring patients remotely in 2018, has spent a lot of time with the Aluna devices.
“You purchase or lease the device from the company for $50 a month,” Miller said. “The company will give you respiratory therapists who teach the patient how to use it.”
The company will monitor patients while they use the spirometer too, which is important because this usage occurs outside the doctor’s office, Miller said. Practices then bill the insurance company via remote patient monitoring codes.
“You have low upfront costs and low maintenance inside your practice,” Miller said.
Hundreds of patients are now in remote monitoring programs across the country, Miller said, with 15 to 18 months of experience. Patient outcomes overall have improved, with fewer ED visits or asthma exacerbations.
Plus, Miller continued, remote home monitoring has improved quality of care as patients gain a better understanding of their triggers such as air quality and pollen counts. Provider satisfaction has improved as well, with reasonable “in office” efforts.
But before practices begin using remote monitoring, Miller cautioned, they should have a plan in place and spend time preparing ahead of launch.
“If you decide to do this, you should identify your goals. You should identify your team, including the in-office champion that’s going to be part of it with you as the provider,” Miller said.
Also, practices need to identify which technology they are going to use and whether that company offers support. Practices additionally need to budget both time and money for using these devices, determine how they will integrate them into their EHR and how they will perform periodic evaluations of their use.
While severe and uncontrolled asthma represent the primary use for remote patient monitoring, its potential in other applications in the allergy and asthma space is considerable as well, Miller said.
“Think about many of the chronic inflammatory conditions that we deal with,” he said. “They are potentially ripe for targeting with remote patient monitoring.”
Additional considerations
Practices may feel compelled to offer remote home monitoring to address gaps in the social determinants of health as well, according to Miller.
Patients may live in areas that are rural, remote or difficult to access, Miller explained, or they may have mobility or transportation issues. Or, he continued, they may have poor access to specialty care.
Although insurance codes are available for remote patient monitoring, Miller encouraged clinicians to advocate for continued telehealth coverage. He also advised clinicians to participate in efforts to provide data supporting the use of remote patient monitoring, because its broad adoption by the specialty is inevitable.
“It’s not a question of if. It’s a question of when,” Miller said. “I think the answer to when is now.”
References:
- AMA. 2021 National Telehealth Survey Report: Allergy/Immunology. https://acaaicollege.wpenginepowered.com/wp-content/uploads/2022/05/Allergy-and-Immunology-Telehealth-Survey-Report-2021-Final.pdf. Published May 16, 2022. Accessed Jan. 4, 2023.
- Kocher B. NEJM Catal Innov Care Deliv. 2021;doi:10.1056/CAT.21.0141.