Remote Patient Monitoring

Remote Patient Monitoring is a growing branch of telehealth. In human medicine, this is commonly seen when monitoring glucose levels in diabetic patients, blood-oxygen levels, pulse, blood pressure, and so on. In veterinary medicine the idea is the same.

The Next Wave for Telehealth

Imagine waiting a month and a half for the opportunity to have a 10-minute conversation. Then, when the opportunity comes, you have to wait another four to six hours to get into the room with the person you are anxious to talk with. At first glance, it may seem as if we are in the days of the Pony Express.

GettyImages-1217676328.jpgNow, let’s add the layer of stress that comes with that conversation being about a sick, uncomfortable, or recovering pet. Things may begin to look familiar. This is the current status of many veterinary clinics across the nation: overbooked and understaffed. Everyone is feeling the burnout, from the veterinary staff to the clients and especially the patients.

The pandemic unfortunately drew attention to an issue that had been recurring for a long time. Veterinary clinics are not able to keep up with the massive need for veterinary care across this nation. One solution is to increase the number of veterinary professionals entering the field. But, in order for that to work, there needs to be more professionals joining than those who are leaving due to burnout. One more realistic solution is a larger-scale implementation of telehealth, in particular remote patient monitoring (RPM).

What Is Remote Patient Monitoring?

RPM is the process of monitoring a patient outside of a clinical setting. In human medicine, this is commonly seen when monitoring glucose levels in diabetic patients, blood-oxygen levels, pulse, blood pressure, and so on. In veterinary medicine the idea is the same.

Remote monitoring allows for the patient to go about their day in their familiar environments, reducing stress levels and providing more accurate data. (For example, an elevated pulse at home is different from an elevated pulse in the clinic.) Once the patient is being monitored constantly, there are two modes of care that can be pursued.

In the first mode, the veterinarian receives information directly from the device. The data reveals a pattern, and if the pattern is within normal limits, all is well. If not, the veterinarian may contact the client to request additional information and possibly schedule an office visit.

“The biggest asset to telemedicine has been and is currently a high-definition camera attached to the internet.”

—AARON SMILEY, DVM

In the other mode, the client may notice a change in their pet and contact their veterinarian. The veterinarian will be able to converse with the client while looking at the information gathered from the remote patient monitoring. If there is no immediate cause for concern, more monitoring can continue. If there is a cause for concern, the veterinarian may make a recommendation remotely or the patient can again be brought in for an office visit.

Both scenarios reduce the need for follow-up and check-in appointments. This creates room in a practice’s schedule for more urgent cases and new clients. Then, the cycle repeats.

How Does Remote Monitoring Relate to Telemedicine?

According to the National TeleHealth Resource Center Partners, telehealth is broken up into four sections:

  • Synchronous (teleconferencing)
  • Asynchronous (electronic communications)
  • Remote Patient Monitoring
  • Mobile Health (text messages, alerts, and reminders)

GettyImages-1263936417.jpgAs a branch of telehealth, RPM has the same benefits as the rest and can be easily combined with all of them. Patients that need to be monitored (but not necessarily in a clinic) benefit greatly from this because they get to return to their normal routines. This has been shown to decrease stress levels and allow for more accurate diagnoses and treatments. In addition, a patient monitored from home opens up space for more critical patients that do need to be monitored in the clinic.

When a follow-up or a check-in is needed, RPM can be combined with teleconferencing or asynchronous communication in order to eliminate the need for in-person scheduling. The veterinarian can talk directly with the client, see the pet on a video, and view what needs to be viewed. The appointment is completed within a few minutes without adding stress to the patient, the client, or the veterinary staff!

Why Is This So Important?

While there is still some pushback with telemedicine in the veterinary profession, the persistent need for a change isn’t going away soon. According to the American Pet Products Association’s 2017–2018 survey, there were 89.7 million dogs and 94.2 million cats owned in the United States. In their 2019–2020 study, 63.4 million US households had at least one dog and 42.7 million households had at least one cat. The numbers don’t lie: 67% of US households have at least one pet. That number isn’t declining. In fact, with the pandemic we have seen an increase in pet adoptions.

While there is still some pushback with telemedicine in the veterinary profession, the persistent need for a change isn’t going away soon.

In addition to all of that, the highest expense most of these owners cite is their veterinary expenses (both routine and surgical). In other words, a lot of people are owning pets and have a desire to take care of them and see them in good health. The demand is there—it is the supply that is the issue. There are only so many appointments that can be scheduled within a day. Even larger hospitals are becoming overwhelmed by the volume.

Allowing nonurgent cases and questions to be solved remotely takes some of the load away, resulting in a reduction in the amount of in-person appointments being scheduled through the day. As a result, this makes room for more urgent appointments and emergencies.

An even bigger issue is access to care. Veterinary practices are not everywhere. In some areas, a veterinary clinic can be hours away by car, even if a client has guaranteed transportation. For those that have no way of transportation, this presents an even bigger problem. Many of these clients have no issues making arrangements for long drives for an emergency or even a yearly check-up. However, follow-up and check-in appointments at any frequency are not as feasible. RPM is the best option in these cases.

Ways to Implement RPM Now

In areas or clinics where telemedicine is newer or in more established areas where there are some financial constraints, remote monitoring can still be used.

“The biggest asset to telemedicine has been and is currently a high-definition camera attached to the internet,” said Aaron Smiley, DVM, a veterinary telemedicine advocate and consultant. “The biggest move forward in telemedicine has been the invention and mass production of the smartphone.”

Because of this, he has been able to implement asynchronous telemedicine within his own practice and serve his clientele remotely. Smiley utilizes remote monitoring in combination with asynchronous communication.

If patients have to check-in or follow-up on a procedure that doesn’t yet require an in-person visit, he messages the clients through a secured app and receives videos and updates on whatever he needs. He could take a resting respiratory rate from a short video of a pet actually resting at home as opposed to attempting to take a rate in a clinic from an already excited pet. He can also watch an arthritic patient move in their familiar environment and observe for pain management.

GettyImages-1222475873.jpgFor patients that have at-home monitoring systems already for chronic illnesses, he asks them to report the more recent readings within the same app. The readings are then recorded in the patient’s records. From there, Smiley says he is able to make his recommendations, and if an in-person appointment is needed, those are easy to do. According to Smiley, the biggest step is making sure that everyone is comfortable using the technology involved. Everyone can use a smartphone at some capacity. The rest is just a small learning curve.

In addition to that, access to care also includes cost. Many clients with chronically ill pets already have the devices needed at home to monitor their pets. Asking them to buy another device when they can just report the readings through asynchronous communication could be an unnecessary cost.

The Future of RPM

According to Bruce Truman, founder and president of BLT Technology and Innovation Group, “Rapid shift is happening when it comes to overall virtual care.” The overall need is too great for things to stay the same. The critical need for access to veterinary care has resulted in several companies providing solutions to these issues.

Petcare companies that have catered more to supplies have begun offering virtual veterinary care services, which includes 24/7 on-call veterinary advice. These services don’t completely replace a local veterinarian but can supplement in instances when a client just has a question or is seeking advice. Other platforms feature veterinarians that provide more specialized care, such as dermatological and behavioral care.

“Rapid shift is happening when it comes to overall virtual care.” 

—BRUCE TRUMAN, BLT Technology and Innovation Group

In addition to all of that, pet tech is a fast-growing industry, with many companies coming directly from Silicon Valley. These companies are creating devices that can attach directly to the pet via a collar or onto the crate at home. These devices have capabilities of monitoring temperature, pulse, and respiratory rate; behavior; sleep tracking; and potentially even some simpler blood chemistry.

These devices are comparable to the FitBit or Apple Watch. They are meant to allow the client to be more hands-off with the monitoring. Instead of the client having to input the information into an app every time, the device uploads all the information, and it can be accessed by the veterinarian as needed. From there, if the veterinarian needs to recommend a change to the treatment(s), that can be done via remote messaging or during an in-person appointment as needed.

Cost and durability are the biggest selling points for these devices. Nevertheless, the convenience of being more hands-off while still providing the best care to a pet is often worth it.

Final Thoughts

It is a recurring theme that progress for the sake of progress should be discouraged. However, what if progress is the only way to solve the problem? At this point, veterinary medicine has reached a split in the path and we can either carry on as we are and see what happens (not promising) or innovate and move forward.

To continue as things have been will bear the same results. People will continue to be overwhelmed. Veterinarians, techs, and other staff members will continue to leave the profession due to the stress. Clients will continue to be frustrated, and we will all have this discussion again and again with hopes of making better decisions.

The Veterinary Virtual Care Association (VVCA.org) has a list of recommendations for implementing and assessing a practice’s capabilities for providing virtual care including remote monitoring. Some of the diseases it recommends for remote monitoring include (but are not limited to) diabetes, heart failure, and thyroid disease.

At the end of the day, veterinary clinics and hospitals have a mission to see to the needs of as many pets as possible. Continuing as the way things are means turning away more patients. It means more clients consulting Dr. Google and making decisions that aren’t based on medical knowledge. It means greater delays in accurate diagnoses and treatments. It means more suffering for our patients. Virtual care is not the ultimate solution, but it is a step in the right direction.

TS-Bio_pic-Terrisha_Buckley.jpg
Terrisha Buckley is a freelance writer with a bachelor’s degree in biology and an extensive background in research as well as experience working in the veterinary profession.

 

Photo credits: SophonK/iStock via Getty Images

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