Note: This article is part of a series exploring how to unlock the value of remote patient monitoring. The next article in the series explores how medical device companies are using RWE as part of submissions to regulatory bodies. We’ll explore how medical device companies are navigating this segment of the regulatory landscape.
Patient engagement is a critical component of remote patient monitoring. Part of real world evidence (RWE) collection involves patient-reported data. But if medtech companies are to build a collaborative relationship with patients, building trust is critical to get opt-in to share their data. If patients understand why their data is needed and how it will be used, they will be more likely to view this request in a positive light. They’ll see this as a way to help them manage their condition and not as a cynical transactional relationship.
As well as ensuring that accurate, timely data is collected from devices, capturing patient reported outcomes (for example, chronic pain) is also important to build a fuller view of the patient. In a recent webinar on remote patient monitoring and RWE, sponsored by Huma, panelists discussed how they are using patient engagement to trigger earlier interventions, support patients through their care journey and de-escalate the stress and anxiety often associated with managing acute and chronic conditions.
Earlier interventions
One of the exciting opportunities in leveraging RWE and data insights for patients and clinicians is they can lead to earlier interventions for high risk patients. This patient population may include patients with multiple chronic conditions as well as patients recovering from surgery.
AliveCor uses biosensors to convert a smartphone into an EKG to track arrhythmias. This heart condition can be tough to spot in the relatively short window of a physician appointment because they are unpredictable. That spurs the need for data collection over a long period of time when arrhythmias can be detected. The goal of the company is not only to make it easy for patients to collect and share data to avoid a fragmented care experience, but to enable earlier interventions to avoid hospitalizations.
Dr. Archana Dubey, chief clinical officer with AliveCor, shared that by adding remote patient monitoring, the company reduced emergency room visits by 56%. It was also able to cut hospitalization for patients with arrhythmia by 68%.
“That is powerful. That is important … for a primary care physician to better manage and better understand the patients when they’re at home or in the workplace,” Dubey said. “It’s also important for payers because they care about total cost of care reduction.”
In order to provide effective early intervention for the portion of orthopedic surgery patients experiencing complications with recovery, it’s important for that insight to come within one week of surgery. Patient reported data is essential within the week following this surgery, according to Paul Trueman, global VP for health economics and market access at Smith and Nephew. By receiving patient feedback on pain, mobility, and satisfaction through medical device RWE platforms, surgeons are better positioned to respond in a timely manner and, if possible, deliver better outcomes for the patient.
Trueman noted that the medical device industry’s ability to collect and build big data sets based on patient-reported outcomes as they recover from procedures is where the medtech industry can prove the value and effectiveness of their devices in the long term.
“That’s where we start to get signals about overarching product performance, rare [adverse] events. We know that’s occurred in orthopedics in the past where we haven’t had that wholesale data collection – we either missed it as an industry or we found it too late. I think as we start to get more and more data or we recruit more patients …. we’ll start to get those signals a lot earlier and correct [problems] earlier as well.”
As valuable as earlier interventions are, for clinicians to receive and act on data insights for high risk patients, alerts need to be managed in such a way that they don’t create alarm fatigue or otherwise add to the overworked physicians’ caseload.
Supporting patients
Patient engagement with their medical devices is also critical for more subjective measures, especially pain. Abbott’s Neuromodulation division developed the NeuroSphere platform to support virtual care and interactive data collection between patients who have received an implant as part of treatment for movement disorders such as Parkinson’s disease and/or chronic pain.
What’s compelling about this platform from a medical device company is that physicians are able to adjust the patient’s implant settings remotely, based on patient-reported data. Abbott gets right to the sweet spot of the dynamics that can drive increased patient engagement and lead to better outcomes. If patients share data and express discomfort, that engagement will lead to a physician response, adjusting the settings of their implant, and help them feel and move better. This should empower patients and make them feel they can take an active role in managing their condition and potentially reduce their stress. So even patients in rural areas or where neurologists are in short supply can have the same level of access to physicians who receive their data and respond accordingly.
Dr. Erika Ross, director of clinical and applied research of the Neuromodulation division at Abbott, noted that it’s incumbent upon the medical device manufacturer to balance the patient’s ownership of their own data with building interfaces so a clinician can use timely insights based on the patient’s data to make a decision in a short amount of time and communicate with patients as clearly as possible .
“These small movements forward in truly understanding objectively what’s happening in a very subjective disorder, this is going to completely revolutionize an area like the chronic pain practice area,” said Dr. Erika Ross, director of clinical and applied research of the Neuromodulation division at Abbott.
The Covid-19 pandemic has played a role in making individuals more aware of their health and on the alert for symptoms related to the virus. That’s helped make people more engaged in their health generally.
Alex Gilbert, who works in digital medicine at Huma, said Type 2 diabetes patients he’s working with are sharing data from their devices at a rate of 80%, which is an unusually high level of engagement for patients with this chronic condition. The implications are that when patients can see the benefits of sharing data to track and manage their condition they will be more likely to adopt medtech and companion digital health apps at a higher rate. That, in turn, will lead to more patients opting into sharing their information with both medical device manufacturers and hospitals.
“It just pays to be very honest and clear about how data is being transferred and transmitted,” Gilbert shared. “We explain that to patients, we help them to understand the process that’s going on. We’ve actually spent a lot of time in terms of engaging them in the right way and getting them involved.”
De-escalating patient concerns
As the case of Abbott demonstrates, medical device manufacturers are taking on a larger role in patient engagement. It’s part of a slow but widening trend. That interaction is not only illustrated by changing a patient’s device settings in response to them sharing data. It is also reflected by medtech companies using patient data and feedback to de-escalate patient concerns.
Patients using Smith and Nephew’s devices receive an explanation from the company when they’re concerned about the pace of their recovery from surgery or concerns over developments like swelling and stiffness and how long those symptoms will last and give them a sense of the parameters of their recovery.
“We’re not directly intervening,” Trueman explained. “But where we have signs and symptoms of an escalation of an infection, for example, we’re trying to give the patient enough insight and knowledge and education to actually know when to pick up the phone to [call] their provider.”
To optimize patient engagement, it’s crucial for there to be synchronicity between medical device companies, patients, clinicians and payers. When medical device companies build an interface for their devices that supports data sharing between patients and clinicians, this can make it easier for patients to share meaningful data with clinicians and, passively, medtech companies. It can also help patients better understand their condition and motivate them to be more candid about the data they share with their clinicians and even medtech companies. By sharing more personal information in a timely manner, it could improve communication between clinicians and patients and avoid needless trips to the emergency room and reduce complications that lead to hospitalization.
