Chronic diseases like diabetes, heart disease, and cancer are leading causes of global morbidity and mortality, with costs projected to reach $47 trillion by 2030. Many are preventable through lifestyle changes and smart integration of technology in health care. Remote patient monitoring (RPM) offers a promising solution by allowing continuous tracking of health metrics, encouraging better lifestyle management, and reducing preventable complications. According to the American Telemedicine Association, RPM allows patient health data to be collected, transmitted, and evaluated remotely and can provide health care teams with valuable insights outside traditional clinical settings.
For instance, a patient might wear a blood pressure cuff that automatically transmits readings to a doctor. If readings spike, the care team can intervene before the situation becomes critical or requires an emergency visit. This approach not only reduces hospital strain but also improves patient outcomes. In the United States, RPM is in early stages of implementation. Health systems and policymakers are navigating challenges including establishing sustainable reimbursement models, integrating RPM into existing workflows, and ensuring equitable access for diverse patient populations.
Across Europe, where health care systems are largely publicly funded, RPM practices and policies vary significantly from one country to another and offer valuable insights into how different models address implementation and patient engagement for targeted conditions. France, England, and Germany have advanced reimbursement and clinical guidelines for RPM, making them valuable case studies for identifying best practices that could be adopted in the U.S.
France: Cancer Care
France’s centralized health care system has embraced RPM with public reimbursement, making it accessible without supplementary charges for patients with conditions like diabetes, chronic heart, kidney, or respiratory failure, and specific cancers. Cancer treatment often involves a long and challenging regimen that, while essential for care, can be highly stressful, as well as inconvenient, for patients. It can lead to unnecessary hospital stays and complications from treatment, which can significantly impact quality of care.
To help patients undergoing treatment, France is using the CAPRI app, which allows a select group of patients to communicate directly with nursing staff to manage treatment and side effects. Two coordination nurses manage digital interactions, supported by 80 decision trees for efficient responses. In a study of the intervention, about 80 percent of patients’ requests were handled by nurses without needing to involve the oncologist. This reduces the oncologists’ workload but raises questions about the impact on nurses. According to the study, a nurse can follow approximately 125 to 150 patients per year while working full time.
The CAPRI model not only supports patients by evaluating and guiding them but also enhances treatment accuracy and alleviates the stress associated with prolonged and complex therapies.
England: Parkinson’s Disease
In England, the National Health Service funds RPM programs for managing chronic conditions like diabetes and cardiovascular diseases, with new initiatives focusing on Parkinson’s disease. The U.K.’s national standards advise that Parkinson’s patients receive clinical reviews every six to 12 months. However, these visits typically provide only a brief glimpse into a patient’s condition, which is inadequate given the frequent and sometimes hourly fluctuations characteristic of Parkinson’s symptoms.
The Home-Based Care pathway addresses key challenges in Parkinson’s care by integrating at-home monitoring with advanced wrist-worn sensors. The Parkinson’s KinetiGraph watch, which is worn continuously for six days to track patients’ movements at home, is central to this system. The data are transmitted to health care professionals, who can detect signs that medication adjustments or additional interventions, such as physiotherapy, may be needed.
This approach provides patients with support to help them recognize and manage their symptoms effectively. Additionally, the system facilitates direct communication with health care providers whenever necessary, ensuring timely and personalized care.
Germany: Early Cognitive Decline, Dysfunction, or Frailty
Germany’s decentralized health system currently reimburses remote patient monitoring for heart failure, but there is growing interest in addressing the needs of older patients with multiple chronic conditions. Multimorbidity is often linked to a higher risk of adverse drug events, declining physical function, and increased health care use, such as emergency admissions. Additionally, mental health issues like anxiety and depression are more common in this population.
The ATMoSPHAERE study investigated how RPM could support elderly patients by improving connections between general practitioners, therapists, and social services. As part of the study, a Bluetooth-enabled telemonitoring app was developed to monitor blood pressure and heart rate at home. While the app does not directly measure cognitive impairment, it collects indirect indicators through health questionnaires, adherence tracking, and engagement patterns. Challenges such as difficulties completing tasks, irregularity in patient monitoring, or delayed responses can signal potential cognitive issues.
Research from this initiative highlights the fact that successful adoption of RPM technologies requires user-friendly designs, seamless integration into patients’ daily lives, and input from patients during development to ensure the tools meet their needs.
Strategies for the U.S.
The United States can draw the following key lessons from these initiatives:
- The U.S. could adopt nurse-led RPM models, with patient-to-nurse ratios in place to prevent burnout. Using supportive technologies, like AI-driven triage systems, this can help reduce the volume of unnecessary alerts and tasks, further alleviating pressure on health care teams and increasing the time available for patient care.
- England’s approach to Parkinson’s care emphasizes the value of continuous monitoring to manage fluctuating symptoms. Expanding the use of wearable devices in the U.S. could enhance the management of conditions that require detailed, real-time tracking.
- RPM technologies must focus on user-friendly interfaces, particularly for older patients or those with complex health needs. Germany’s focus on tailored telemonitoring for elderly patients with multiple chronic conditions illustrates the importance of designing RPM systems with patient input.
While remote patient monitoring has clear benefits, addressing drawbacks like cost, technological barriers, data overload, equity of access, and privacy concerns is essential for successful implementation. A balanced approach that combines RPM with human-centered care can help mitigate these concerns and ensure RPM enhances rather than complicates health care delivery.
