Remote patient monitoring
Technology and Telemedicine
Telemedicine  is a growing field implementing current technology to improve the reach of medical care. It is often used as a means to deliver specialty care to underserved or remote locations. This has been done through means such as remote stroke assessment  , remote dermatology assessment , and remote monitoring in an intensive care unit (ICU) . As the field of personal health monitoring technology expands, a subset of telemedicine has evolved called Remote Patient Monitoring where patients use technology that directly transmits health data to providers. The data gathered are often referred to as patient generated health data (PGHD) or as a digital phenotype . This means of remote data gathering is ideal for patients with difficulty getting to clinic either due to remote location or health issues. It is most frequently used to monitor chronic health conditions and in the setting of research. The field of remote patient monitoring can be divided into four areas: data generation and collection, sharing or communication data, interpretation, and utilization(1).
Devices Available for Data Generation and Collection
Glucose monitors have improved dramatically in the last few years. Many finger-stick self-monitoring devices can automatically transfer data to a remote storage area such as a phone or online database. Additionally, many people wear a device to monitor their blood sugar around the clock to create for passive data collection, an ideal for remote patient health monitoring. There are several devices for continuous glucose monitoring , , or flash glucose monitoring  which allow for the collection of a robust digital phenotype. While the flash glucose monitors differ from the continuous glucose monitors in that they are not set up to automatically transmit data, the continuous glucose monitors actively push data from the device to designated locations. This can be to the user’s cell phone, a friend or family member, or a physician or other clinician. The allows for remote patient monitoring which can alert other people when the users blood sugar is at an extreme high or low.
Digital sphygmomanometers such as the Omron 10 series , LotFancy  Easy@Home , and many others. Digital sphygmomanometers work by measuring a physical oscillation rather than an auscultation with a manual blood pressure cuff. This digital measurement is less accurate than the other means of measuring(2), its convenience has made it such that it is often used as the first means for blood pressure collection even in a health care setting and use at home mitigates problems such as white coat hypertension and can allow for patterns to be seen such as increasing blood pressure in the morning or at night.
Fall detection is generally done via simple accelerometer data. It has become most widely used on the fourth generation Apple Watch. This device was the first apple watch to incorporate fall detection and can be used to transmit the data to emergency services and has even been known to save lives after high speed bike accidents . However, should you have a sibling in her 30s who has suffered the shame of having two simultaneously broken feet, use caution when recommending this technology as it has connotations of elderly fall risks and implications of diminished agility.
Continuous Positive Airway Pressure (CPAP) CPAP devices are worn to help keep an individual’s airway open while sleeping. These devices were one of the first to monitor and store patient use and reimbursement for the device then became dependent on whether the machine reported that the user was wearing it for the minimum required amount of time .
Weight A 2019 review found that weight was the most common area of PGHD studied(1). This is done both through digital scales, as well as activity monitors and nutrition logs. Unlike other technologies mentioned here, nutrition logs are PGHD dependent on patient input rather than a digital assessment of the patient’s health status.
Submitted by Jennifer Rosenbaum