What to Watch out for in Remote Patient Monitoring Solutions Sector for Chronic Care

By Arunima Rajan

The eyes of many experts and non-experts are on remote patient monitoring solutions due to COVID-19. Still, there are other unanswered questions like affordability, accuracy and interoperability of this care model.

Going to the ICU is often an intimidating experience for the patient with chronic illness and their attenders. If you muster up the courage to go near one, the sight of multiple wires and tubes on the patient is often a common sight. Sachin Indane, a Bangalore based entrepreneur, wanted to end this uncomfortable experience for the patient.

"Entrepreneurial spirit has been in me from my Indian Institute of Science (IISc) days. However, I wanted to find the right technology and timing before taking the plunge," says the CEO of Isansys Lifecare India Pvt Ltd.

One is not surprised, therefore, about the recent spotlight on Remote Patient Monitoring Solutions in India. Isansys is a partly owned subsidiary of a UK company. Indane worked with GE healthcare for 17 years before starting Isansys with his IISc batchmate, Manoj Joshi. Isansys offers wireless and remote patient monitoring for homecare as well as for hospitals. "A Tele-ICU solution shares information about the patients, like their vitals, audio-visual communication and reports. Isansys can give accurate vitals, and for other information, we are tying up with other product development companies," explains Indane.

Innovative Technology

What are the benefits of using the Wireless RPM solution? The most headline-grabbing feature of the industry is the potential for patient comfort. Second, it will be easier for the doctor to manage the patient. The third advantage is the patient's mobility. The patient can walk around and still get monitored thoroughly. It is a boon for Neonates & Paediatric patients as they are entirely free from wires and are not bound to the bed.

Medical Data Gathering

Indane points out that there are two sensors, which go on to the patient body. It's more like a bandaid, but double the length, stuck on your chest and one in the armpit. The sensors send the data wirelessly, and it is displayed on the monitor, which looks like a tablet. The tablet also acts like an input device, where nurses can key in various parameters like patient data, medication etc. The data from the gateway goes to the server, which can be on the cloud or stored in the hospital's server within their security system.

"There have been instances where RPM solutions save the lives of the patients", says Indane, adding, "for one of the patients, oxygen level started dropping, and he went into a state called Happy Hypoxia. The nurse immediately alerted the patient's family, and the patient was given oxygen. The next day heart rate of the patient fluctuated, and the hospital quickly sent a nurse to stabilise the patient."

RPM solutions are more expensive than traditional monitoring devices. Hospitals can either buy it or subscribe as VaaS (Vitals as a Service). Currently, monitoring is considered a super-premium service that hospitals can perform only in the ICU.

Several wearables are offering patient data. But the question is whether a doctor can make a clinical decision based on the data. Accuracy and clinical efficacy approved by FDA & CE come as a strong assurance for doctors & patients.

There are also challenges for the sector. There is a lack of awareness, credible big players and affordable solutions in India. Hospitals must also be willing to change their workflow; if a patient is monitored at home and something goes wrong, the hospital must set up a workflow for such a situation.

Cardiac Design Labs is a manufacturer of monitoring and diagnostic solutions in cardiac and general monitoring. Anand Madan Gopal, Founder and CEO of Cardiac Design Labs, is one of the most recognisable faces of the RPM race. "We have our products in Cardiac Monitoring for Holter in multi-lead and Patch for long term monitoring. We also have a Tele-ECG platform. Our new Padma Vitals product is a Step-down ICU Ward monitoring solution ideal for remote monitoring even at home and in the ambulance. It gives ICU quality monitoring in a wearable form. It has easy to wear options without electrodes so that anybody can put them on to get ICU level data, including ECG and cardiac analytics," explains the CEO of Cardiac Design Labs.

What is an RPM solution?

He points out RPM is a solution that gives data collected from patients in an organised form with analysis and alerts and provides real-time access when necessary. "There is a growing demand for these solutions, as managing patients recovering in hospitals becomes very efficient. Also, home management of patients post-discharge and chronic disease is very efficient and easy on the patient. Today cardiac monitors own the largest share, but the future is for all types of monitoring," he explains. He warns that hospitals should look at three critical factors. "a) Is the solution producing values that are matching with the gold standards. b) Most often, the sensors placed in the wrong places on the body for convenience will not produce valid results. Taking decisions based on that can have adverse results c) Does the solution work with multiple devices from different manufacturers. It can be quite cumbersome and challenging for patients," concludes Madan Gopal.

Cardiotrack

Avin Agarwal is the Chief Executive Officer at Cardiotrack. Agarwal finished his engineering in Medical Electronics. After a brief stint in the Netherlands, he came back to Bangalore and partnered with St. Johns Hospital. However, he soon realised his solutions were not going to market. So he built the company Cardiotrack along with Dr Ashim Roy in 2014. "We wanted to bring medical care/screening to primary care centres. Today, medical screening is done at labs/hospitals. We want to take it out of labs and hospitals to primary care clinics. So we decided to build an integrated medical platform, which has cloud backing for data portability, integrated with medical devices. The first device we picked up was an ECG device. We spent four years designing a portable 12-channel medical-grade ECG device integrated with mobile and cloud backup. That was the first device brought to the market. Over time, we added more medical devices to the same platform, more features including teleconsultation as well as opinion on reports," explains Agarwal.

Agarwal notes that the main reason behind starting his company was to take screening to the remotest areas of the country at a price point that can be affordable for the primary care clinics.

He also points out that in the west, RPM is more about cost optimisation. "In India, there are healthcare centres available for every category of patient. We are trying to make the system more convenient and make it more predictive/preventive. Today there are many players offering teleconsultation integrated with remote patient monitoring solutions. For an RPM solutions developer, Indian is a relatively smaller market, but if the company can get in to services along with the product, then India is a big market," he explains.

Telemedicine is the root of RPM in India?

Remote Patient Monitoring and telehealth are walking hand-in-hand; together, they have waived off the limitations of healthcare and have brought out the best healthcare delivery for all times. "Medical devices such as glucose monitors, foetal monitors, electrocardiograms, and blood pressure monitors can monitor many patient behaviours and conditions. Recent achievements in micro/nanofabrication, flexible and stretchable functional materials, and wireless communications offer attractive and versatile capabilities in wearable electrochemical sensors. Through RPM and telehealth, accessibility to healthcare has gone through a significant change resulting in easy, affordable access to quality healthcare," says Satish Kannan,Co-founder and CEO, MediBuddy.

Has the future arrived ahead of schedule?

Dozee is another major player in Contactless Remote Patient Monitoring (RPM) solutions.

"Remote Patient monitoring is a safe and efficient system to measure a person's vitals without physical contact. The process is seamless, continuous and highly accurate. Not just at one's home, RPM plays an integral part in enabling healthcare staff to remotely control patients in the ward levels outside ICUs without having to visit them manually. "The platter of benefits that RPM offers can empower the hospitals in the country to tackle the crisis of healthcare worker shortage and facilitate the best healthcare delivery to the patients,” says Mudit Dandwate, CEO & Co-founder, Dozee.

The next big thing or another fad?

"The Global Remote Patient Monitoring Market is anticipated to be valued at USD 2.14 Billion in 2027 from USD 786.4 Million in 2019, registering a CAGR of 14.1% through the forecast period. However, the COVID-19 pandemic has pushed healthcare practitioners towards remote patient monitoring technologies in India and also globally," he adds. Dandwate points out that RPM can improve healthcare professional's lives significantly. "It enables nurses and healthcare professionals to optimise their work as they no longer spend time checking vitals in every ward," he adds.

To 2022 and beyond

So if a hospital wants to invest in an RPM, what factors should they look at? According to Indane, "First, they should look at the accuracy and consistency of data because lives are at stake. Technology needs to be robust to avoid motion artefacts or false data due to chest electrodes coming off. The second factor is the ease of use for caregivers/nurses. Third, hospitals don't want devices working in isolation. They want the data provided by the solutions to be integrated into their IT systems/EMR/Hospital Information systems," he concludes.