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Evo Terra: MetaStar Health IT Radio is a podcast series that features consulting content experts and covers topics regarding the Wisconsin Medicaid EHR Incentive Program Promoting Interoperability, formerly Meaningful Use, as well as a behavioral health technical assistance initiative. Episodes covered will guide your practice, clinic, hospital or hospital system through the complex federal/state requirements of the PI program.

MetaStar has helped more than 2000 providers attest to Promoting Interoperability as Wisconsin's regional extension center since 2010 and continues to provide attestation assistance and audit preparation as a consulting service.

We are joined by Parker Garman, a health information and quality specialist from the Wisconsin Primary Healthcare Association, WPHCA, to share some information about remote patient monitoring. I'm your host, Evo Terra.

Thanks for being here, Parker. I think it makes sense to start with a definition of remote patient monitoring. How do you define RPM?

Parker Garman: Yeah. Thanks for having me on first of all. It's great to be here. So RPM, like you said, stands for remote patient monitoring. And I think really that's the use of digital technologies to monitor and capture medical and other health data from patients and then electronically submit this information to healthcare providers.

So that can be as low-tech as a provider giving one of their patients a blood pressure cuff and a journal. And over the next two or three months, that patient records their blood pressure in the journal and then comes and gives that journal back to the provider who then looks at the blood pressure and maybe make some recommendations on how to update their medications or provide some dietary changes.

And then it can be as high-tech as maybe the patient has a blood pressure cuff that has a Bluetooth connection to their phone. And through the phone, they're able to transmit their blood pressure directly into the chart and the provider is able to in a real-time basis see as that patient takes their blood pressure right at home.

Evo Terra: Right. The idea of being connected all the time, connected to all things, why not connect some patient monitoring devices as well? Now, in the past, we've had some episodes regarding telehealth. I know we're talking about something different, but maybe you could expand on that just a moment. What's the difference between telehealth and remote patient monitoring?

Parker Garman: Yeah, so I think telehealth really involves more synchronous activity. So that's the patient and the provider talking at the same time. You know, maybe over a video visit or over Zoom or maybe just over the phone; while remote patient monitoring, that can be asynchronous and can be occurring at different times. So maybe, you know, it's after dinner and you sit down to take your blood pressure using your blood pressure costs, and maybe you have the high-tech option and that data transmits directly into your chart. And so the next morning the provider is able to see, "I see that, you know, patient Smith took their blood pressure at 7:00 PM last night. And their systolic was a little high, a little elevated, but that's okay."

When you think about in a larger context, both telehealth and remote patient monitoring are going to play a big role moving forward. And I think a lot of healthcare providers and healthcare organizations are beginning to have these discussions of how do they work together. I think there's a lot of innovative and potential opportunities to think about how do we care for patients between visits and when they're not in our four walls in the healthcare organization and telehealth and remote patient monitoring both play a large role in that.

Evo Terra: Absolutely. And I think that asynchronous versus synchronous data collection and information gathering and conversations are certainly going to help. There are probably a lot of applications that we could have and currently do have for remote patient monitoring. What are you seeing in the field right now?

Parker Garman: Yeah. So I think one is, I kind of previously mentioned, it really allows patients and providers to engage in care between visits. So you don't need to necessarily go into the doctor's office to take your blood pressure. I think another aspect that's growing and and that really presents a great opportunity is it really allows and empowers patients to engage in their care, because if you're taking your blood pressure twice a day, that might affect as you go and look at your blood pressure, or you look at your other health data yourself, that might alter "What am I going to eat today? What kind of exercise am I going to get today? Am I going to get exercise today?" And so that it gives you an ability and an opportunity to think about your health when you're not at that doctor's office.

And from a provider perspective, it gives them additional insight into "When I'm not seeing my patient, how are they behaving? How are they acting? And how can I better tailor a care plan and engage with them so that we can work together to improve the lives and care for patients?"

Evo Terra: Yeah. I think there are benefits on the patient and the provider side as well. Have you seen any impact specifically on the provider side? I guess the question is do doctors like this?

Parker Garman: Yeah. I think it's a really new and growing field. And so I think from talking with providers, there's definitely interest and desire. And I think it's a little early to say, you know, the impact or the benefit, but I think we see a lot of significant opportunity. Definitely from talking with providers, there is some excitement around this, in the possibilities and abilities to engage with patients in new and innovative ways.

Evo Terra: Let's stay on the topic of new and innovative ways. Not all doctors are into new and innovative. So what are some of the factors that have really helped encourage providers to use RPM with their patients?

Parker Garman: Yeah, so I think, you know, if you look at the last year with COVID, there was a really large need to continue to support patients with chronic conditions while reducing in-person visits wherever possible. And so there was this real need to be innovative in this space. For patients who have hypertension or diabetes or other chronic ailments, how do we continue to see them? How do we continue to manage it and work with them to manage their chronic illnesses? All while maybe they don't want to come into the office or it's not safe for them to come into the medical office. They're not able to have those standard annual wellness visits. And so this created this huge need of patients over the last year. You know, diabetes, hypertension, these kinds of chronic illnesses, they did not go away. So there was this need to be innovative of how do we care for patients who can't come in right now or are unable to come in or unwilling to come in. And so remote patient monitoring has a large opportunity to help fill that gap, so that you can care for patients with chronic illnesses between visits.

I think as more and more healthcare organizations continue to move towards that patient-centered care model and provide robust support to patients beyond the standard office visit and really trying to emphasize the patient's own role in their healthcare and see patients as partners, RPM is a really great example of how sort of that looks in practice.

Evo Terra: It's an exciting field to be sure, but as you mentioned in practice. From your experience, are there some barriers that are stopping people from starting a remote monitoring program?

Parker Garman: Yeah. So I think there can be a high cost of entry and we still see the technology tends to still be maturing and can be a little bit expensive. Patients particularly for the high-tech option need to have a smartphone along with the remote patient monitoring device. And on that smartphone, they often need to have multiple apps in order to facilitate the data exchange between your remote patient monitoring device and the electronic health record where the provider would sort of see that information.

And so oftentimes that creates some barriers in terms of how do you set up this program? And how do you do so in a way that minimizes the burden on both the provider and the patient? Because I think we've seen in the past the more barriers that you set up between that patient and provider, the harder it's going to be for that to happen. And so those additional barriers can sometimes make standing up a program somewhat challenging.

Evo Terra: Sure. So barring giving everybody a smartphone and forcing the price down, which will happen eventually, what are some strategies that might help mitigate some of these barriers?

Parker Garman: Yeah, definitely. So I think don't be afraid to start small and start with a low-tech option. I think sometimes when we think about remote patient monitoring, we think of the high-tech sleek setup where everyone has a smartphone and the remote patient monitoring device has a Bluetooth connection to their smartphone and all of this technology. But you don't need to start with that. You can start small. Maybe it's just giving out some blood pressure cuffs to a few patients that you think might be able to use it and ask them to log that information in a journal or call once a week to the nurse and report that information right over the phone. Because I think ultimately, being able to have patients engage in their care and see that can be really beneficial. And that's also another way to start small. You can take small bites of the apple.

Evo Terra: And how do people get in touch with you, Parker?

Parker Garman: Yeah. So people can email me at pgarman, so it's pgarman@wphca.org.

Evo Terra: Fascinating information of health in the future. Thank you very much for all the information, Parker.

Parker Garman: Yeah. Thanks for having me on and take care.

Evo Terra: Once again, that was Parker Garman, a health information and quality specialist from the Wisconsin Primary Healthcare Association. Thank you for listening to MetaStar Health IT Radio. I have been your host, Evo Terra. For more information on this topic and to access resources mentioned, please visit metastar.com/podcast. That's M-E-T-A star dot com.