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The promises of remote-monitoring technologies

The Bottom Line

  • Remote patient monitoring is the delivery of healthcare services to people outside of conventional clinical settings (for example, at home) using telecommunication technology.
  • Despite its promises, the clinical effectiveness of remote-monitoring technologies is still debated among researchers. Nevertheless, there is evidence that remote-monitoring technologies can: improve access to quality health information; help make informed decisions; increase feelings of security and autonomy; help make clinical decisions more rapidly; and more.
  • There is still a lot of work to address various sources of concerns among potential users (notably about the acceptance of such technologies, how it may impact their lives and identities, and how to protect their privacy).

 

Home, sweet home.

Home is often synonymous with familiarity, comfort, security, love and much more. Many of us hope to grow older in our home (for as long as possible), instead of moving to an assisted-living facility or a nursing home. This may require some home modifications, and perhaps new support and services to meet the evolving health and social needs of older adults.

Remote-monitoring technologies and other virtual-care services appear promising to support aging in place. Remote patient monitoring is the delivery of healthcare services to people outside of conventional clinical settings (for example, at home) using telecommunication technology.(1) These technologies transmit health data (sometimes in real time) about a person to their care provider through a variety of devices (for example, sensors, wearables devices, handheld devices, mobile smartphones, implantable devices, blood-pressure monitors, and technologies using artificial intelligence to analyze speech and behaviours).(1-2) These technologies can be used by care providers to observe a person’s health status (for example, their vital signs and symptoms) and behaviours (for example, medication adherence) from a distance.(2) Many programs currently exist to remotely monitor people who have chronic conditions like diabetes, heart failure, chronic obstructive pulmonary diseases, or for patients who are transitioning back home after a surgery.

And that’s not it. The technological landscape is evolving rapidly, and the scope of possibilities keeps growing exponentially to also include remotely monitoring people’s wellbeing and home environment. Technologies are now increasingly used to remotely monitor activities of daily living of individuals with the goal of tracking their health status and foreseeing the risks associated with aging in place.(3)

What can we learn from the body of research evidence about remote-monitoring technologies and whether there are fulfilling their promises?

What the research tells us

There is a growing body of evidence about the purposes of remote-monitoring technologies. These purposes include:
- helping people manage their care needs at home for as long as possible (for example, increased autonomy, improving medication adherence, or increase comfort, convenience, and flexibility in chronic disease management);(4-7)
- supporting post-discharge monitoring to avoid hospital readmission or intervene earlier to mitigate negative health impacts (for example, faster clinical decision-making, react to critical situations, call for help in the case of an emergency and issue warnings if unusual behaviours are detected);(8-11)
- enhancing safety (for example, preventing falls and wandering);(5;12)
- improving access to specialist care (13) or overcoming workforce shortages (particularly in rural and remote areas);(14) and
- reducing or preventing the use of unnecessary care (for example, hospitalization, hospital stay, consultations, outpatient visits and follow-up, and emergency department visits).(7;9;15-18)

There is a wide array of things that can be remotely monitored, including:
- physiological parameters (for example, blood pressure, heart rate, weight, electrocardiogram, fever, oxygen level) (12;19);
- routine actions (for example, phone use, room presence, bed/chair occupancy, toilet usage, fridge, pantry access) (12;20); and
- home environment (for example, temperature and CO2 level).(11)

Despite its promises, the clinical effectiveness of remote-monitoring technologies is still debated among researchers.(1) Nevertheless, there is evidence that remote-monitoring technologies can:
- improve access to quality health information;
- help make informed decisions;
- increase feelings of security and autonomy;
- help make clinical decisions more rapidly;
- reduce hospital readmissions;
- help patients living in rural and remote areas to manage their health and care; and
- support medically unstable patients as they transition to stability at home.

A lot of interest, but also many issues still to be addressed

The 2021 Digital Health Survey commissioned by Canada Health Infoway revealed that many Canadians have an interest in a variety of electronically enabled health services, and the, many expressing an interest in:
- taking part in a remote patient monitoring program using a device to manage a chronic health condition (47.2% of respondents); and
- taking part in a remote patient monitoring program using a device to manage symptoms related to COVID-19 (40.2% of respondents)

While these survey results show a lot of interest in using remote-monitoring technologies, there is still a lot of work to address various sources of concerns among potential users (notably about the acceptance of such technologies, how it may impact their lives and identities, and how to protect their privacy). We also need to put in place strategies to bridge the ‘digital divide’. The digital divide refers to the socio-economic and demographic factors such as age, income, ethnicity, place of residence, education and health status that contribute to unequal access to digital infrastructure and technical capacity of individuals and communities to access information and use the internet.


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References

  1. Bain T, Al-Khateeb S, Bhuiya AR, et al. Rapid synthesis: Identifying remote-monitoring technologies to enable existing level of care. Hamilton, Canada: McMaster Health Forum, 2022.
  2. Sinn C-LJ, Pasat Z, Klea L, et al. A maturity model framework for integrated virtual care. Journal of Integrated Care 2022; ahead-of-print(ahead-of-print).
  3. Calvaresi D, Cesarini D, Sernani P, Marinoni M, Dragoni AF, Sturm A. Exploring the ambient assisted living domain: A systematic review. Journal of Ambient Intelligence and Humanized Computing 2017; 8(2): 239.
  4. Secretariat MA. Home telemonitoring for type 2 diabetes: an evidence-based analysis. Ont Health Technol Assess Ser 2009; 9(24): 1-38.
  5. Jaana M, Paré G. Home telemonitoring of patients with diabetes: a systematic assessment of observed effects. Journal of Evaluation in Clinical Practice 2007; 13(2): 242-53.
  6. Nilsson MY, Andersson S, Magnusson L, Hanson E. Ambient assisted living technology-mediated interventions for older people and their informal carers in the context of healthy ageing: A scoping review. Health Science Reports 2021; 4(1): e225.
  7. Gettel CJ, Chen K, Goldberg EM. Dementia care, fall detection, and ambient-assisted living technologies help older adults age in place: A scoping review. Journal of Applied Gerontology 2021; 40(12): 1893-902.
  8. (CADTH) CAfDaTiH. Remote monitoring for cardiac conditions: A review, 2022.
  9. Dawes AJ, Lin AY, Varghese C, Russell MM, Lin AY. Mobile health technology for remote home monitoring after surgery: A meta-analysis. Br J Surg 2021; 108(11): 1304-14.
  10. Sapci AH, Sapci HA. Innovative assisted living tools, remote monitoring technologies, artificial Intelligence-driven solutions, and robotic systems for aging societies: Systematic review. JMIR Aging 2019; 2(2): e15429.
  11. Queirós A, da Rocha NP. Ambient assisted living: Systematic review. In: Queirós A, Rocha NPd, eds. Usability, Accessibility and Ambient Assisted Living. Cham: Springer International Publishing; 2018: 13-47.
  12. Choukou MA, Polyvyana A, Sakamoto Y, Osterreicher A. Ambient assisted living technologies to support older adults' health and wellness: A systematic mapping review. European Review for Medical and Pharmacological Sciences 2021; 25(12): 4289-307.
  13. Maric B, Kaan A, Ignaszewski A, Lear SA. A systematic review of telemonitoring technologies in heart failure. Eur J Heart Fail 2009; 11(5): 506-17.
  14. Banbury A, Roots A, Nancarrow S. Rapid review of applications of e-health and remote monitoring for rural residents. Aust J Rural Health 2014; 22(5): 211-22.
  15. Meneses-Echavez JF JT, Holte HH, Harboe I, Underland V, Zinöcker S. Remote patient monitoring and resource use in the specialized health service: an overview of systematic reviews. Norwegian Institute of Public Health 2022.
  16. Klersy C, De Silvestri A, Gabutti G, Regoli F, Auricchio A. A Meta-Analysis of Remote Monitoring of Heart Failure Patients. Journal of the American College of Cardiology 2009; 54(18): 1683-94.
  17. Dang S, Dimmick S, Kelkar G. Evaluating the evidence base for the use of home telehealth remote monitoring in elderly with heart failure. Telemed J E Health 2009; 15(8): 783-96.
  18. Thomas EE, Taylor ML, Banbury A, et al. Factors influencing the effectiveness of remote patient monitoring interventions: a realist review. BMJ open 2021; 11(8): e051844-e.
  19. Bashi N, Karunanithi M, Fatehi F, Ding H, Walters D. Remote Monitoring of Patients With Heart Failure: An Overview of Systematic Reviews. Journal of medical Internet research 2017; 19(1): e18-e.
  20. Pinto-Bruno Á C, García-Casal JA, Csipke E, Jenaro-Río C, Franco-Martín M. ICT-based applications to improve social health and social participation in older adults with dementia: A systematic literature review. Aging & Mental Health 2017; 21(1): 58-65.

DISCLAIMER: These summaries are provided for informational purposes only. They are not a substitute for advice from your own health care professional. The summaries may be reproduced for not-for-profit educational purposes only. Any other uses must be approved by the McMaster Optimal Aging Portal (info@mcmasteroptimalaging.org).

Many of our Blog Posts were written before the COVID-19 pandemic and thus do not necessarily reflect the latest public health recommendations. While the content of new and old blogs identify activities that support optimal aging, it is important to defer to the most current public health recommendations. Some of the activities suggested within these blogs may need to be modified or avoided altogether to comply with changing public health recommendations. To view the latest updates from the Public Health Agency of Canada, please visit their website.

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