Risk: Home but not alone

Along with remote consultations, remote monitoring is part of a rapidly changing area of technology known as telemedicine. Telemedicine can be defined as the delivery of healthcare services, such as assessments or consultations, over the telecommunications infrastructure, allowing providers to evaluate, diagnose and treat patients without the need for an in-person visit.

Remote monitoring allows patients to be monitored in their own homes through the use of mobile medical devices that collect data. It’s much more than just recording blood sugar levels, blood pressure and other vital signs – advances in information technology combined with a growing demand from patients could trigger a revolution in remote health monitoring over the next few years.

A recent report from the M2M (machine to machine) technology market research firm Berg Insight has highlighted how quickly the use of remote health monitoring is expanding. It estimates that in 2016, 7.1 million patients were remotely connected to health monitoring devices. It expects this number to grow by over 40 per cent per annum over the foreseeable future – and greater integration of information technology in healthcare is a key strategy for all UK Governments.

Remote monitoring can be a useful way of improving care by giving patients greater involvement in managing their health and providing continuous tracking of their symptoms, so that interventions can be made before any problems become acute. Because the technology is becoming more user-friendly and unobtrusive to wear, patients can carry on with their normal activities. Increasingly, the software that tracks this information can be integrated into everyday devices, such as smartphones, tablets and now smartwatches, which should help to speed up adoption. However, this new technology does not come without some risks.

A standard for the assessment and approval of safe healthcare apps (as with MHRA approval of healthcare devices) is currently being established, but in the meantime it is important to conduct a comprehensive assessment before introducing new technology into practice. This should include carrying out a privacy impact assessment as required by the General Data Protection Regulation (GDPR). This is basically a risk assessment focusing on the potential impact of a data breach through the introduction and use of monitoring devices and software.

Clinicians will also have to set local standards for the use of remote monitoring by patients. These could be established through profiling different conditions. Patients will have to be aware that an alert might be triggered without them even knowing about it if the monitor is set up to send frequent readings across 24-hour periods.

Clinical staff should be trained in the proper response to alerts and the escalation strategy for each particular patient. Systems should be set up within the practice to ensure that monitoring alerts are dealt with in a timely manner. Without appropriate attention to monitoring alerts, a practice might miss an opportunity to deal with an emerging issue and prevent a serious problem.

‘Alert fatigue’ could also become a risk if system triggers are not set properly, leading to alerts being ignored – which can be very tempting if they are frequent and of a low level. Doctors should specify the alert trigger strategy for each patient so that they are aware of what is “normal” for that particular patient. It is also vitally important to agree how a doctor will contact the patient to discuss issues for urgent follow-up. Additionally, the patient’s family may need to be made aware of what is arranged so that if the practice has to contact, say, a wife or husband, there is no potential for a breach of confidentiality. All such issues should be discussed with the patient and recorded in the case notes.

To ensure continuity of care, monitoring information needs to be compatible with the clinical system so that information can be stored in the patient record and retrieved easily. Responses to all alerts should be documented with an audit process in place to ensure that monitoring procedures are adequate. Monitoring information should also be reviewed with the patient at regular clinic visits to reinforce adherence to care and treatment plans.

ACTION POINTS

• Carry out a privacy impact assessment before deciding whether to use a device.
• Train staff in proper responses to alerts and the escalation protocol.
• Specify and agree with each patient a “trigger strategy”.
• Review monitoring information with the patients at regular clinic visits.
• Document all responses to alerts in the clinical record.