Remote Monitoring of Patients with Heart Failure

Remote Monitoring of Patients with Heart Failure The advancement experienced in various aspects of health care delivery have led healthcare providers to adopt novel strategies with the aim of improving delivery of care services as well as the outcome of care for different patient populations. The adoption of telehealth modalities is one of the strategic moves adopted by care providers in different care settings.

Telehealth refers to a set of modalities for improving health care, health education and public health delivery as well as support through telecommunication technologies.

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All technologies that are used to deliver virtual health, medical and educational services are classified under telehealth. Advancements in communication and electronic data management have contributed to success in telemedicine and remote patient monitoring (Gussak & Antzelevitch, 2013).

This paper will address the topic of remote monitoring of patients with congestive heart failure.

A description of the target population, as well as the demographics of individuals with CHF, will be provided. The advantages and shortcomings of using remote patient monitoring will be highlighted together with the role of nurses in applying this modality. Security issues and the best practices associated with the use of remote patient monitoring will also be included.

The Population and Demographics of Individuals Served Using the Resource Congestive heart failure patients comprise a huge portion of the patient populations served using remote patient monitoring. Congestive health failure is a progressive disorder that occurs when the heart does not sufficiently pump blood to the other body parts. This condition emanates from certain conditions such as hypertension and coronary artery disease which leave the heart muscles weak, severely damaged and unable to pump blood efficiently (Maria, Giordano, Emanuele, Andrea, & Giovanni, 2018). That fact that most of the conditions that cause heart failure are irreversible increases the need for long-term patient care. The treatment plan for CHF patients comprises of lifestyle change, dietary change, weight loss, and stress management recommendations to improve the quality of life of the patient. Collins et al. (2013) noted that most of the CHF patients who present in the emergency department are not always severely ill. Majority of these patients do not require acute intervention and invasive diagnostic testing. Collins et al. (2013) argued that more than half of these patients could be discharged safely following a brief session of observation. However, to minimize the incidences of

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unnecessary admission and readmissions, there is a need to continue monitoring these patients.

Monitoring health nurses to determine whether the patient is adhering to the recommended preventive measures. Gensini, Alderighi, Rasoini, Mazzanti, and Casolo (2017) noted that periodic monitoring of symptoms as well as a review of pharmacological therapy results in a significant decrease in hospital readmission rates for CHF patients.

Role of Nurses in Remote Patient Monitoring The involvement of nurses in remote monitoring of CHF patients significantly increases the chances of a positive outcome. Nurses are directly involved in the assessment, diagnosis, treatment, and management of CHF patients. Consequently, they understand the health needs and interests of the patient population. Notably, different remote monitoring strategies can be applied when dealing with CHF cases. Nurses have a responsibility to identify the most appropriate monitoring technique to apply for individual patients. Once that most reliable remote monitoring technique has been identified the nurse ensures that all equipment is installed in the patient’s home (Maria et al., 2018). For instance, in situations where video calling will be involved in monitoring the nurse ensures that the necessary hardware is installed both at home and at the hospital. The other role of the nurse is to train the patients on the use of the selected remote monitoring technique (Snell, 2014). Training ensures that the patients are provided with the basics of using the monitoring platform. Another role of the nurses is to collect patient data from remote monitoring sessions and analyze it critically to identify areas that need improvement.

When dealing with CHF patients, the nurses should collect data concerning the weight of the patient, the nutritional aspect, the lifestyle of the patient as well as compliance with the medication regimen (Snell, 2014).

Advantages and Disadvantages of Remote Patient Monitoring

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There are numerous potential benefits of remote patient monitoring for clinicians and the patients. Some of the benefits to clinician include the ease of access to patient data, improved ability to provide patients with high-quality care, and decreased risk of burnout. Patients also benefit immensely from remote monitoring. The primary benefits of this modality include improved access to healthcare, improves support education and feedback from health care professionals, improved quality of care and peace of mind and daily assurance (Mohammadzadeh & Safdari, 2014).

Remote monitoring makes it possible for care providers to attend to a larger number of patients. Furthermore, remote monitoring ensures that care providers are closely connected with their patients. A base is, thus, established on which clinicians are provided with up to date information concerning the health of the patient. Another benefit of remote monitoring is that it improves patient behavior (Mohammadzadeh & Safdari, 2014). The system created through remote monitoring ensures that the patients are more engaged with besides being accountable for their health.

Importantly, remote patient monitoring creates a comforting assurance among patients that someone is concerned and watching out for their health and well-being. The patients feel like the healthcare team went home with them. The continuous, instantaneous connection between patients and caregivers ensures that the patient is provided with an expanded level of education and support as well as feedback (Gussak & Antzelevitch, 2013). These aspects of care cannot be provided by some of the traditional modalities of care delivery. Remote monitoring ensures that health care providers are not only collecting the health information of the patients but are also providing actionable feedback to the patients (Gussak & Antzelevitch, 2013).

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However, there are some disadvantages associated with remote patient monitoring. One of these shortcomings is that remote monitoring is not accessible for all patients. Rural hospitals and small healthcare facilities experience challenges in establishing remote monitoring programs due to lack of good connectivity. Many people in the rural areas do not have the smart gadgets required in remote monitoring.

Another disadvantage of remote monitoring is the doubtful reliability. Many smart devices used in remote monitoring have huge error margins that make them unreliable when making medical decisions (Mohammadzadeh & Safdari, 2014). Mohammadzadeh and Safdari (2014) also noted that the success of the remote patient monitoring is dependent on the willingness of the patient to take part in their care. The implementation of remote patient monitoring is highly likely to fail if the patient is not willing to participate.

Equipment, Privacy, Facilities, Technical Assistance, and Set Up of the System The implementation of a remote patient monitoring program must put into consideration the equipment required, the facilities and stakeholders involved, technical assistance and the setup of the system. These factors must contribute to the establishment of a concrete platform for communication between care providers and the patients. The equipment necessary for remote monitoring program includes smart gadgets, communication platforms such as Bluetooth communication technology, as well as data storage and analytical tools. Before patients are enrolled in a remote monitoring program, the nurse must ensure that that the necessary communication gadgets are installed in their homes. These gadgets may include a computer, a smartphone, internet connectivity apparatus, or wearable devices where necessary.

The privacy of the system must also be looked at to ensure patient information is not leaked to third parties. One of the ways to improve the privacy of the system is to set passwords

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for both the patient and the healthcare team members. A team of health information technology (HIT) specialists should be involved in the establishment of the remote patient monitoring program. The role of this team is to provide the necessary technical assistance. Furthermore, the team should be actively involved in the installation of the system at the patient’s home and the hospital.

Security of the System Security of the remote patient monitoring system is of paramount importance. Measures should be put in place to guarantee maximum security for individually identifiable information.

Patients should be given an opportunity to set up passwords to minimize access of third parties to their portals. Nurses should ensure that video calls, which form a vital component of remote monitoring, are conducted in areas where other parties cannot identify the patient. The patients can be identified using codes and patient identification numbers rather than their personal information. The monitoring system can be based on cloud computing infrastructure to improve its security and accessibility. Cloud computing is a reliable base for remote monitoring programs since it enhances the utilization of shared resources (Neogy, 2015).

Best Practices of the System The best practices associated with remote patient monitoring include reminders concerning healthcare information, improved patient care, patient education, and critical evaluation of patient health information for medical decision making (Buttigieg, 2015). Remote monitoring establishes on which patients can easily access care in a time of need platform also allows care providers to educate patients concerning some of the best interventions to manage health disorders and prevent complications (Buttigieg, 2015). Importantly, care providers can monitor the patient’s level of compliance with the treatment plan. In cases where deviations are

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identified, the care provider can advise the patient accordingly to alleviate potential adverse health outcome.

Conclusion Advancements in communication and electronic data management have contributed to success in telemedicine. Numerous telehealth modalities have been developed and applied in the management of patients with different health conditions. Remote patient monitoring is one of the relevant telehealth modalities that can be applied in the management of patients with chronic health conditions. This modality has numerous benefits including providing patients with the assurance that someone is watching over their health. Remote monitoring establishes on which patients can easily access care in a time of need platform also allows care providers to educate patients concerning some of the best interventions to manage health disorders and prevent complications.

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References Buttigieg, S. (2015). International best practices in health care management. Bingley, UK: Emerald.

Collins, S. P., Pang, P. S., Fonarow, G. C., Yancy, C. W., Bonow, R. O., & Gheorghiade, M. (2013). Is hospital admission for heart failure really necessary? The role of the ED and observation unit in preventing hospitalization and re-hospitalization. Journal of the American College of Cardiology, 61(2), 121)–126. http://doi.org/10.1016/j.jacc.2012.08.1022 Gensini, G., Alderighi, C., Rasoini, R., Mazzanti, M., & Casolo, G. (2017). Value of telemonitoring and telemedicine in heart failure management. Cardiac Failure Review, 3(2), 116–21. doi. https://doi.org/10.15420/cfr.2017:6:2 Gussak, I., & Antzelevitch, C. (2013). Electrical diseases of the heart: volume 2: diagnosis and treatment. Lawrenceville, NJ: Springer Science & Business Media.

Maria, S., Giordano, L., Emanuele, T., Andrea, F., & Giovanni, M. (2018). Antepartum fetal monitoring through a wearable system and a mobile application. Technologies 6(2), 44.

Mohammadzadeh, N., & Safdari, R. (2014). Patient monitoring in mobile health: Opportunities and challenges. Medical Archives, 68(1), 57–60. http://doi.org/10.5455/medarh.2014.68.57-60 Neogy, S. (2015). Design and implementation of remote medical health monitoring system.

Retrieved from https://ieeexplore.ieee.org/document/6757119 Snell, A. (2014). The role of remote care management in population health. Retrieved from https://www.healthaffairs.org/do/10.1377/hblog20140404.038196/full/