Should our health system invest in device-based Remote-Patient Monitoring (RPM) or Digital Care Journeys (a.k.a. Deviceless RPM)?

The short answer is you don’t have to invest in one or the other.

Many health systems leverage device-based RPM to reach the 5% of patients most at-risk for chronic care management and then use Digital Care Journeys to reach the other 95% of patients in a scalable way. Although some health systems only use Digital Care Journeys to have a consolidated approach.

The following diagram provides a high-level overview of the differences between the two approaches.

In the rest of this post we will dive deeper into each of the areas below to provide you with a more detailed understanding of how the two approaches compare.

Technology and Approach: What exactly is involved?

Device-based RPM: Providers deliver a kit with a tablet and wireless devices for daily symptom and biometric monitoring (e.g., weight scale, blood pressure cuff). A healthcare team gets alerted for abnormal readings and intervenes earlier.

Digital care journeys: Also known as deviceless or app-based RPM solutions. Health systems engage patients with personalized digital care journeys via the patient’s own smartphone, tablet, or desktop computer to send surgery or condition-specific reminders, deliver pre- and post-care education and monitor symptoms. Patients can self-monitor via automated workflows (e.g., receive automated guidance on how to manage constipation post-surgery) and providers can get alerts and dashboards to monitor patient progress remotely (e.g. pain, incision photos).

The main difference: While Device RPM only focuses on symptom/vitals monitoring, Digital Care Journeys do all of that AND provide customizable, out-of-the-box step-by-step education for the patient to follow. This allows the patient to be even more empowered in their care and rely less on clinical staff.

Clinical areas: For which patient populations is the technology used?

Device-based RPM: Generally used for chronic care management, such as congestive heart failure (CHF) and COPD due to the technology’s primary focus on biometric monitoring.

Digital care journeys: All patient populations. Not only for chronic care, but also women’s health, orthopedics, oncology, cardiology, urology, mental health, palliative care and more.Click here for an example library of the broad range of surgical procedures and health conditions supported by digital care journeys.

The main difference: Digital care journeys are a lot more flexible. Why? Because Device RPM is focused on biometric/vitals monitoring, it’s not applicable to many populations.

For example, device RPM isn’t designed to send reminders leading up to an endoscopy or track knee range of motion after a knee replacement. Moreover many health conditions and surgeries require tracking of patient self-reported data instead of biometrics, such as nausea, pain, mood, anxiety, etc. All of this is better suited to digital care journeys.

This also shows in the clinical evidence and research, where most evidence for device RPM is centered on chronic care, whereas digital care journeys have a broader scope of proven results for much more than chronic care.

Staff resources required: How much time and effort is needed to manage these initiatives?

Device-based RPM: High staff time per patient because staff are required to monitor every patient and the data being collected.

Digital care journeys: Low staff time per patient because 80% of patient issues are low-risk and managed with automated self-care education (e.g. managing constipation), leaving only 20% of higher risk patient issues needing to be escalated to a clinician. Moreover care teams can be as hands on or hands off as they like - the implementation can range from self-management only programs (no staff monitoring, instead its patient self-monitoring) or higher touch with alerts and dashboards for clinicians to reach out to patients proactively at the sign of trouble.

The main difference: Clinical teams are already stretched thin, and many can’t afford to do device RPM. The low-touch high impact approach of Digital Care Journeys provides a more flexible way for care teams to leverage remote monitoring.

Scalability: How many patients can a health system practically reach?

Device-based RPM: Due to the high staff requirements and narrow set of clinical conditions supported, most health systems can only use device-based RPM to support upwards of a few hundred patients per year (e.g. the top 5% of patients most at-risk).

Digital care journeys: Due to needing far less staff resources and being scalable to all health conditions and surgical procedures, health systems can use digital care journeys for potentially 100% of all patients. With this scalability, it’s not uncommon for health systems to use digital care journeys for tens of thousands of patients per year.

Cost differences: Moreover, digital care journeys are also far more scalable from a cost perspective. The significant cost of device-based RPM (including hardware kits, logistics management, software and services) means the total cost per patient is often 5 to 20 times higher than digital care journeys (software and services only).

Phases of care: How much of the care continuum can the technology support?

Device-based RPM: Generally used for post-discharge and ambulatory (outpatient) care only. This is because there’s no real use for biometric/vitals monitoring before a hospital stay or while preparing for a surgery.

Digital care journeys: Used pre-admission/pre-op, in-hospital, post-discharge and ambulatory. This is because digital care journeys not only support symptom/vitals monitoring, but they also can provide step-by-step reminders and education to help patients prepare for surgery or a hospital admission (e.g. stopping blood thinners a week before surgery) and motivate in-patient recovery (e.g. nudging the patient to get up and ambulate while in hospital).

The main difference: Device-based RPM works well for specific time periods especially after discharge, but only digital care journeys can be a single solution for the entire continuum of care.

Key Performance Indicators (KPIs) improved: What impact does the technology have on health outcomes?

Device-based RPM: The symptom/vitals monitoring and post-discharge focus means device-based RPM is strong at mainly post acute-care support, particularly reducing ED visits readmissions.

Digital care journeys: Being strong at engaging and monitoring patients across the entire continuum - from pre-admission guidance to post-discharge recovery - enables digital care journeys to have a broader impact on KPIs beyond improving readmissions and ED visit rates, but also lowering length of stay and phone calls, and increasing patient volumes.

The main difference: If you are particularly focused on reducing hospital length of stay and increasing patient throughput/volumes (which is a common focus among health systems today), digital care journeys are a stronger choice.

As an example, below is a snapshot of how MultiCare used digital care journeys to reduce length of stay, readmissions and cost of care - while also increasing contribution margins. Click here for the detailed case study.

User experience: how integrated is the technology with our existing EHR and patient portal?

Device-based RPM: Often a fragmented, separate user experience for both clinicians and patients - lacking seamless integration with the EHR and patient portal.

Digital care journeys: Flexible, turn-key FHIR integrations that allow the patient experience to be embedded in a patient portal/digital front door and the provider experience to be embedded in the EHR patient cart.

The main difference: Digital care journeys are better aligned with health system digital and IT leaders who want to maintain a single, consistent patient experience. On the provider side, digital care journeys have better staff engagement because enabling dashboards (e.g. for remote monitoring) to be embedded right in the EHR is faster and easier for clinicians to use than a standalone web portal.

Click here to learn how digital care journeys can integrate with Epic, Oracle Health (Cerner), MEDITECH and more.

Want to learn more about digital care journeys (a.k.a. deviceless RPM)?

Click here to watch an overview and live demonstration of digital care journeys.