Managing and Implementing Remote Patient Device Data in the EHR

This monthly blog highlights and discuss emerging trends and challenges related to healthcare data and its ever changing life cycle.


By Kapila Monga

“Mr. Watson—come here—I want to see you.”

These were the first words spoken over the telephone by inventor Alexander Graham Bell on March 10, 1876. According to popular legend, this call was also the first time the telephone was used to summon help, as Bell had just spilled acid.1 In a way, we can look back on this incident as prophetic, with the advent of telemedicine capabilities. Today, remote patient monitoring encompasses various audio, video, and augmented reality-related technologies and processes used for health information exchange between a patient and physician system. This is also sometimes called “connected health.”

While the healthcare industry gears up to address various organizational, logistical, and social challenges surrounding the usage and adoption of remote patient monitoring, HIM professionals also need to prepare themselves for the onset of this new era. A lot has already been written on how the function of HIM departments would change in next decade,2 and remote patient monitoring adds another dimension to this evolving function:

Information Integrity

Remote patient monitoring introduces a plethora of data from point of care (Bluetooth devices/connected health devices being used by patients in their home settings) like vital signs, weight, oxygen level, blood sugar level, blood pressure, heart rate, etc. to the electronic health record (EHR). Not all of this data maps to a patient visit or an encounter; as the remote health devices transmit this information back to the provider systems, HIM professionals ought to be able to decipher if, where, and how this information goes in the EHR system. The traceability of information back to point of collection is equally pivotal. While some of this will be addressed by EHR vendors through their evolving system designs, HIM professionals—by virtue of their place in the health information management lifecycle—would still have a critical role to play in ensuring the value of EHR can tangibly be improved by remote health data without compromising the integrity of the EHR.

Information Usage

While the connected health devices will transmit information to the provider systems almost on a 24/7 basis, how that information is used will to a large extent fall in HIM professionals’ purview. A sudden increase in sugar level for a non-diabetic person might not be an alarm, and could be just attributed to a sweet indulgence on the part of the individual, while the same spike in blood sugar for a diabetic patient could be a call for action. Rules, alerts, and medical judgment calls would need to be defined as to how and when this real-time health information translates to the need for a healthcare decision. HIM professionals will likely be the gatekeepers who will receive this remote health information, and hence would have an important role to play in defining how this information gets used, and the associated protocols.

Confidentiality and Protection

A connected health device continuously gathering and transmitting patient health data over the internet is a ticking time bomb when it comes to data security. While HIM professionals may not have had a huge role in data protection in the past, with this new health information coming in on an almost real-time basis, HIM professionals’ expertise is needed to develop and implement proper protocols for how and when to analyze the information, how to identify and receive relevant information, and how to dispose of information when needed after analysis. What’s more, an emergency situation caught by means of a connected health device will introduce new care intervention points in the form of unplanned, though maybe timely, connected health device alerts. Having proper methodologies and protocols to handle those would become the need of the hour in that scenario. For example, a patient might have requested non-disclosure of his medical conditions to family members, but in an event when a connected health device used by the patient sends an emergency alert to the provider or HIM professional that results in a 911 call, how the non-disclosure gets handled should be governed by a pre-defined protocol and policy.

Information Lifecycle

Connected health devices and remote patient monitoring will bring in a flood of data. Imagine Bluetooth devices, glucometers, and blood pressure monitors sending data continuously to provider systems. HIM professionals typically oversee the accuracy of health data, facilitate/perform audits, and facilitate information retrieval. They will have a very critical role to play in terms of designing protocols for managing the lifecycle of connected health data/patient monitoring data, including a role in audits of the health data, and in augmenting and supporting patient care

Information Governance

This is the most interesting part of all. Healthcare rules and regulations and reimbursements policies for remote patient monitoring/connected health are evolving with time. It is critical for HIM professionals to continuously update themselves on the legalities surrounding the usage of this data, as well as on reimbursements to provider systems for providing and monitoring care using this technology. The laws here typically vary by state and by plan, so it is prudent for HIM professionals to devote time to keeping apprised of the relevant laws and how they apply.3

Realizing the Benefits of Connected Health

While remote patient monitoring certainly has value to offer to providers, there are multiple obstacles to consider and overcome in order for providers to get the most benefit out of this technology. There are many unfortunate realities that need to be confronted as the industry makes strides toward making connected health a reality for everyone, such as the fact that the oatients who need this type of care the most are often the farther from where it is currently available, that not all health insurance carriers reimburse for these services. Needless providers all over are already making strides to overcome these hurdles, and opportunities to move toward a more connected health-friendly system will continute to arise for providers in the future.

Notes
  1. Aronson, Sidney H. “The Lancet on the Telephone 1876 – 1975.”  https://pdfs.semanticscholar.org/ea46/5b2cecc1535ca330d8e6b6ae32ce4eb45354.pdf.
  2. Dimick, Chris. “Health Information Management 2025: Current ‘Health IT Revolution’ Drastically Changes HIM in The Near Future.” Journal of AHIMA 83, no.8 (August 2012): 24-31. http://library.ahima.org/doc?oid=106207#.WRkC8CDyvDc.
  3. Center for Connected Health Policy. “Remote Patient Monitoring.” http://www.cchpca.org/remote-patient-monitoring.

 

Note: The opinions expressed in this article are the author’s own and do not reflect the view of the organization author works for, or of any other corporate entity.

 

Kapila Monga (kapila.monga@gmail.com) is a Healthcare Analytics professional with 10-plus years of experience across consulting and analytics, for healthcare and life sciences customers. She currently works with Cognizant Technology Solutions in their Healthcare Analytics practice in the US and helps healthcare customers leverage transformative power of analytics and data science to make their business processes more effective.

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