Why this exists

Two related things travel under similar names and are worth separating. RPM — remote patient monitoring is physiologic data reported from a device between visits: blood pressure, weight, oxygen saturation, heart rate. RTM — remote therapeutic monitoring is device-reported data on a person’s therapy and function between visits, rather than a point-in-time observation — adherence, musculoskeletal function, respiratory measures, response to behavioral therapy. This program uses both, and for a chronic pain population the therapeutic and functional signal is usually the more useful of the two.

A patient on long-term therapy for a chronic condition is seen occasionally and lives the rest of the time. Almost everything that goes wrong — deterioration, a new symptom, a medication problem, a developing crisis — happens in the interval. The current system finds out about it either at the next visit or when it has become an emergency.

That interval is where the stranded population is created. A patient who cannot get a prescription filled, or who is in withdrawal, or who is deteriorating, has no route to say so that anybody is listening on.

How it works

• Consented, explained and revocable. A patient who withdraws from monitoring continues to receive care. If that is not true in a given deployment, the deployment is wrong.
• Scoped to what will be acted on. Collecting a signal that nobody will respond to is a cost with no benefit and an unnecessary privacy exposure. If nothing changes when a reading changes, the reading should not be collected.
• Paired with psychometrics, because the deterioration that matters most in this population is often psychological rather than physical.
• A route in as well as out. Monitoring that only flows toward the clinic is surveillance. Monitoring the patient can use to raise a problem is care.