Hospital vs Home Monitoring Comparison

SUMMARY:

• Remote patient monitoring (RPM) has grown dramatically since the pandemic and is expected to continue.

• Clinicians cannot assume a monitoring strategy in the inpatient setting will correctly transfer to home monitoring

• Data generated at home are products of the environment as well as patient status.

---

REVIEW

• The explosive use of remote patient monitoring devices (RPM) provides data in the patients home environment.

• We are familiar with hospital acquired data, however, data from home possess a unique new set of issues.

• Patients within the hospital are in a more controlled environment for data collection.

• Data from the home setting provides a more realistic view from the patients typical environment.

Similarities:

• In both settings we need to determine:

  • Monitoring data can be continuous or intermittent in both locations

  • Data ownership: What data belongs to the patient vs the health system?

  • What is the right volume of data?

    • Large data volumes become challenging to manage

    • Longer windows between data points makes deterioration detection more difficult (i.e. true changes versus outlier data).

    • Spot monitoring introduces time lags

  • Determine if unexpected values are actual (real change, normal variation) or false (artifact, user error) or both.

• What is the appropriate use of RPM in the hospital setting?

• Determining inter and intra-variability of the monitoring tool.

• How each monitoring system will be used in it’s unique ecosystem must be considered.  This includes:

  • Data flow into EHR

  • Interoperability

  • Security

  • Aggregation of data

  • How missing or erroneous results are addressed

Similarities in Monitoring

Differences:

• Noisy Data

  • Both options produce noise, however, most are familiar with hospital noisy data and it is accounted for.

  • Noisy data at home is a new and more unique setting most clinicians are not yet familiar with.

• Clinical validation in each environment and target population.

• Monitoring Response Titration:

  • Determine the right “Monitoring Dose” to capture meaningful changes in data.

  • Different titration at home vs standard monitoring in hospital.

  • Develop a unique Monitoring Dose Response Curve

• Individualized Alarms

  • Do not rely solely on alarms.

  • Trend alerts tailored to individual patients clinical condition and at home circumstances.

  • Establish normal baseline level of activity and variability.

  • Up front agreed upon escalation plan as different individuals in different locations maybe monitoring the data, assessing the patient, and modifying the alarm.

  • Find the correct balance between sensitivity and specificity

• Rounding

  • No set schedule

  • Review objective, subjective and asynchronous communications as frequently as necessary.

Differences in Monitoring

CONCLUSIONS:

• Currently there does not exist a standard of care for responding to data from home.

• Commonly used inpatient approaches cannot be transplanted to the home environment.

• The most useful information regardless of location couples objective data with clinical findings within a patient context.