What Is Remote Patient Monitoring (RPM)? An Expert Guide

The World Health Organization identifies remote patient monitoring as one of a handful of healthcare delivery models with the potential to vastly improve global health outcomes. By monitoring patients’ chronic and acute medical conditions using smart devices, RPM can improve medical diagnoses and treatment decisions and help patients manage their own care.

RPM is also the foundation of virtual, home-based clinical trials. Because such trials are more convenient for participants, they have the potential to expand recruitment diversity, improve patient adherence to trial protocols, and speed up the delivery of trial results.

In the wake of the COVID-19 pandemic, the US government loosened restrictions so providers could more easily offer remote care across state lines. It was initially considered a temporary measure, but the American Hospital Association is pushing for telehealth flexibility rules to become permanent because of clinician shortages nationwide, especially in rural parts of the country.

What Is Remote Patient Monitoring (RPM)?

Remote patient monitoring lets clinicians access at-home and mobile devices, including wearables, to monitor and manage their patients’ chronic and acute medical conditions, such as heart disease, diabetes, cancer, asthma, irregular sleep patterns, and even difficult pregnancies. These devices include blood pressure and heart rate monitors, blood glucose meters, smart inhalers, smart scales, apnea monitors, and maternity care monitors.

The line between a wearable device that simply monitors, for example, heart rhythms or body temperature, and a device that has a therapeutic purpose, such as devices that manage pain levels by manipulating neuro signals is still in flux. That uncertainty means that manufacturers need to take care that during the development and marketing of a device, regulatory issues, such as those around efficacy and safety, are tracked and managed. Failure to do so may have severe impacts on both manufacturers and patients.

Some monitoring devices require the patient to periodically self-test. Others are always on, taking measurements and sending that data directly to the patient’s electronic health record. Some RPM systems let patients use their own devices, such as their smartwatch or phone, to connect to their provider without requiring additional equipment. Others combine devices with smartphone apps. For example, cardiologists can direct patients to use an electrocardiogram (ECG) app that connects to a small heart monitor to detect heart arrhythmias.

Key Takeaways

• “Bring your own device” RPM lets patients use wearable devices they already own and are familiar with, such as smartwatches and exercise trackers. Clinicians can also monitor patients using more sophisticated devices, approved by the US Food and Drug Administration (FDA), that measure and report heart rate, lung capacity, glucose levels, and other metrics.
• The security of patient data needs to be top of mind for healthcare organizations implementing RPM programs. Data must be stored in systems that allow access only to the people who need to view it.
• RPM reimbursements from the US Centers for Medicare & Medicaid Services increased 19-fold between 2019 and 2021 (the latest data available)—from $5.5 million to more than $101 million.
• Thirty-four state Medicaid programs covered RPM services as of March 2023, though many programs restrict use in some way—for example, by only reimbursing home health agencies, restricting the kinds of clinical conditions that can be monitored, and identifying a narrow set of monitoring devices that can be used.

Remote Patient Monitoring Explained

Remote patient monitoring enables healthcare providers to manage acute and chronic conditions. Although questions about data security and privacy remain, RPM use, which skyrocketed during the COVID-19 pandemic, shows no signs of slowing down.

As people become more comfortable with RPM technologies—whether as apps on their mobile phones or smartwatches, or as standalone devices—they’re seeing the benefits in terms of improved health outcomes and time saved (to the extent they can reduce the number of visits to doctors’ offices and hospitals). Meantime, clinicians gain a more regular and clearer view of their patients’ health status, as they collect data they can use to react more quickly to changes in patients' health conditions and, in the longer term, better identify health trends.

Some providers are even setting up “command centers” with technicians who monitor incoming data. For example, Mayo Clinic has a heart rhythm monitoring laboratory that not only performs in-person tests but also monitors data generated by devices worn by patients. When an unusual reading comes in, technicians can respond immediately to help ensure patients receive the proper care.

However, RPM data privacy and security are becoming a major issue. The Bipartisan Policy Center recommends that the US Department of Health and Human Services (HHS) determine whether existing privacy policies adequately address the issue and determine the effectiveness of cybersecurity safe harbor laws, which provide protection against lawsuits and encourage organizations to improve their cybersecurity. The center also recommends that HHS work with the Office of the National Coordinator for Health Information Technology to ensure standards are in place for RPM devices to interoperate with EHRs.

It’s important for RPM patients to receive up-front training and ongoing support to increase their levels of comfort and trust and avoid false alarms due to equipment failure or misuse. Clinicians, who in some cases worry that RPM will increase their workload due to the large amount of patient data that’s generated, need automated tools that can “learn” from repeated exposure to vast amounts of data and surface only what’s truly valuable.

10 Benefits of Remote Patient Monitoring

Remote patient monitoring is becoming more popular as more health organizations develop formal programs for it and as public and private payers reimburse for it. The following 10 benefits can accrue to patients and providers.

1. Timely detection of health issues
   
   Rather than relying on information gathered during intermittent office visits—or sudden trips to the ER—doctors using remote patient monitoring have access to a steady stream of health data. That data can trigger alerts leading to timely treatment interventions, and it can help patients become more invested in their own health status, as they’re able to see readings in real time. For example, people with diabetes who are constantly alerted to highs on their continuous blood glucose monitors are more likely to adjust their diets and lower their carbohydrate intake to help reduce A1c levels and decrease their susceptibility to heart, eye, foot, and other complications.
   
   
2. Enhanced patient engagement
   
   When care providers have better visibility into the ongoing health conditions of their patients—ones with chronic obstructive pulmonary disease (COPD) and certain cancers, for example—they can better engage with and treat those patients. Patients themselves also become more engaged with their own health status, improving outcomes. In a 2021 study by Mayo Clinic, high-risk COVID-19 patients who used RPM devices had fewer emergency room visits and intensive care unit admissions and lower hospitalization and mortality rates.
   
   
3. Cost-effectiveness
   
   The cost-effectiveness of RPM varies depending on the type of monitoring, the disease being monitored, and the type of organization conducting the monitoring. Preliminary research from health economics firm ISPOR indicates that RPM may be most effective in improving the quality of care and lowering costs for hypertension, congestive heart failure, and COPD patients, as well as in helping to control infectious disease outbreaks by limiting exposure to such patients. Many of the cost savings attributed to RPM come from reductions in hospitalization rates. A 2021 study of COVID patients in Cleveland, Ohio, revealed 87% fewer hospitalizations and 77% fewer deaths among those who were monitored remotely after discharge.
   
   
4. Streamlined workflows
   
   By letting care providers monitor multiple patients simultaneously, RPM can make it easier for them to prioritize patients experiencing the most severe symptoms. Doctors can focus on patients onsite while clinical staff monitor remote device alerts and notifications and escalate issues to doctors. In some RPM systems, staff members reach out to patients directly when they see anomalous data—for example, to find out if a patient whose lung capacity readings are low is experiencing nausea or shortness of breath.
   
   
5. Support for value-based care
   
   Value-based care—a model in which clinicians’ compensation is tied to their patients’ health status rather than the number of services they deliver—relies on effective data collection, analysis, and sharing to enhance collaboration among different members of a patient’s care team. Extending care outside the walls of a care facility and actively monitoring vital health data can help care teams catch issues early, before symptoms worsen, and make it possible for patients and providers to determine patients’ health status in near real time.
   
   
6. Enhanced clinical decision-making
   
   By accessing RPM data, clinicians can prioritize patients who require immediate attention while providing guidance and education to patients with chronic conditions to prevent acute episodes. Providers gain a more holistic view of their patients, which they can use to develop personalized care plans.
   
   
7. Increased patient volume
   
   RPM reduces the number of visits patients need to make to healthcare facilities for the periodic collection of health metrics, enabling clinicians to see more patients who need care onsite. RPM can also help health organizations operate more efficiently—for example, it allows pulmonologists to collect data regardless of the patient’s or the primary care provider’s location, allowing for more efficient communication between care givers, which in turn allows clinicians to see more patients during their shifts.
   
   
8. Integration with electronic health records (EHRs)
   
   Remote care data can be integrated with EHRs, facilitating better communication between healthcare providers—for example, by speeding up the transfer of data from a specialist’s office to the patient’s primary care provider. It’s crucial that health organizations choose RPM software that connects multiple devices with different EHR systems.
   
   
9. Facilitation of population health management
   
   The biggest benefit of RPM for population health management is its ability to help keep sick patients out of healthcare facilities during a community disease outbreak, which can slow exposure rates and reduce the spread of the disease. Using RPM to monitor symptoms, such as fevers and respiratory problems, lets providers and community health officials track surges and ebbs in disease outbreaks and monitor the overall health status of a community. This allows them to determine which neighborhoods are hardest hit and take action to help those patients return to health and keep others from becoming ill. In addition, RPM can help community members who have difficulty traveling to care facilities.
   
   
10. Improved patient satisfaction
    
    Patients who actively engage with RPM programs overwhelmingly report high levels of satisfaction. In a survey of Mayo Clinic patients in 2021 and 2022, for example, 89% agreed or strongly agreed that the provider’s RPM program had helped them feel comfortable managing their condition at home, and 93% said they would recommend remote patient monitoring to people with similar conditions. To promote active engagement, patients must receive sufficient training and support on RPM tools and processes. The American Medical Association has identified four key imperatives: Ensure patients are confident in the technology they’ll be using; motivate them to participate and generate accurate data; make sure they understand how their data will contribute to healthy outcomes; and empower them to troubleshoot problems as they arise.

Remote Patient Monitoring Devices in Healthcare

RPM devices make it possible for patients to track and report on their own health metrics. They also allow providers to view a patient’s day-to-day health status and gain a more accurate view of the progress of chronic conditions. These devices not only let providers respond to sudden events, but they also help them track health trends over time. The following are some of the most common RPM devices.

• Blood pressure cuff
  
  Internet-connected blood pressure cuffs help clinicians assess the effects of hypertension medication on patients, improve control of the disease, and predict cardiovascular events. Home blood pressure monitoring can also help detect masked hypertension, whereby blood pressure measurements are normal in-clinic but heightened outside, and white coat hypertension, whereby a patient’s blood pressure measurements are higher in a doctor’s office due to anxiety.
  
  
• Glucometer
  
  Glucometers measure blood glucose levels at regular intervals, showing the readings to diabetes patients so they can adjust their insulin levels and, in some cases, sending the data to care providers. For example, a medical center in Colorado has a program whereby technicians monitor the data and, when they observe an unusual blood sugar spike or decline, contact the patient to determine the cause. Continuous glucose monitors contain small tubes called cannulas that are inserted below the skin, transmitting data to a reader or smartphone app. Some systems even send data to an insulin pump also attached to the user, which automatically adjusts insulin delivery.
  
  
• Pulse oximeter
  
  Pulse oximeters measure oxygen saturation levels and heart rate. Remote pulse oximeters send this data to care providers who can view alerts and take action if a patient’s condition worsens. For example, a pulse oximeter can alert an oncologist if a lung cancer patient’s oxygen level drops, which may indicate that the current treatment is ineffective. In a study published in The Lancet, remote patient monitoring via a pulse oximeter was shown to be effective in determining whether patients needed to be admitted to a hospital and helped care providers triage patients to avoid the unnecessary use of emergency services.
  
  
• ECG
  
  Patients with various types of heart disease use remote ECG (electrocardiogram) systems to measure heart rate, body temperature, respiration rate, and other variables to continuously check for abnormal symptoms. In the past, patients wore cumbersome cardiac monitoring “vests,” which required them to go into their doctor’s office to upload data. If the device failed to capture any anomalies, the process would begin again. Now, with remote ECG systems, a patient can attach a small device to their chest that streams continuous cardiac data to their cardiologist’s office, letting technicians respond to any unusual events immediately. For example, Mayo Clinic’s cardiac program uses a device that tracks patients’ ECG and motion data wherever they are, which is especially helpful for people who live in rural areas or face other obstacles to visiting a hospital or doctor’s office.
  
  
• Peak flow meter
  
  Peak flow meters measure the amount of air patients can expel from their lungs in one vigorous exhale. Since lung diseases sometimes progress gradually, it’s important that patients with conditions such as asthma, emphysema, and chronic bronchitis understand how their lung capacity changes over time. Bluetooth-enabled peak flow meters can send lung function measurements directly to a patient’s electronic health record.
  
  
• Wearables
  
  Smartwatches and fitness trackers are the most common health wearables, allowing patients to track their heart rate, sleep patterns, calories burned, steps, sun exposure, and other health-related indicators. Almost one-third of respondents to a 2023 survey partially funded by the US National Heart, Lung, and Blood Institute said they use a wearable device to track health and fitness, and more than 80% said they would be willing to share their data with their health providers.
  
  
• Thermometer
  
  Remote patient thermometers pointed at a patient’s forehead take temperature readings and automatically transmit that data to the provider through a wireless connection. Such thermometers are commonly used to track the temperatures of patients with health conditions such as cancers (where a fever is a leading indicator that the condition is worsening), as well as those in postoperative care. Mayo Clinic included such thermometers in a kit provided to patients at high risk of experiencing complications due to COVID-19.
  
  
• Scale
  
  Wireless scales allow care providers to monitor a patient’s weight fluctuations remotely. For patients with obesity, such scales can help clinicians and patients alike identify the impact of behavioral and diet changes. A new type of scale recently approved by the FDA measures both weight and fluid retention, helping clinicians predict heart failure episodes.

Practical Applications of Remote Patient Monitoring Solutions

Originally intended to track patients with chronic and acute diseases, remote patient monitoring is also being used to monitor pregnant, elderly, postsurgical, and other kinds of patients. What follows are the most common practical applications of RPM.

• Chronic disease management
  
  Chronic diseases such as heart disease, diabetes, and asthma are increasingly tied to unplanned emergency hospital use, according to research from the Centre for Online Health at The University of Queensland, Australia. RPM can help lighten the load on the healthcare system by detecting fluctuations in a patient’s health status, enabling clinicians to intervene before a hospital visit is needed.
  
  
• Postoperative care
  
  Complications from surgery include pain, infection, blood clots, shock, and hemorrhaging. Helping patients avoid the most serious complications is a challenge for healthcare providers. RPM devices, particularly those that require little to no patient intervention, let clinicians track relevant postoperative health indicators such as heart rate, temperature, and frequency of movement, allowing patients to recover at home.
  
  
• Elderly care
  
  As the average age of populations worldwide trends higher, the ability to monitor and support older adults in their homes is crucial. RPM systems designed to support older people include motion detectors, temperature sensors, and bed monitors that can alert remote caregivers and emergency responders if help is needed.
  
  
• Maternal and fetal monitoring
  
  Remote maternal and fetal monitoring systems, which measure the fetus’s heart rate and response to uterine contractions, often come in the form of smartphone apps. They enable care providers to remotely monitor their pregnant patients and let patients make informed decisions about their own care. In a study published in the journal JMIR mHealth and uHealth, researchers determined that remote fetal monitoring seemed to reduce the incidence of neonatal asphyxia and lower care costs compared with routine fetal monitoring in health facilities. According to the World Health Organization, there are nearly 2 million stillbirths every year, with more than 40% taking place during labor—losses that could be avoided with improved quality of care, including routine monitoring and timely access to emergency care.
  
  
• Medication management and titration
  
  Medication management, or titration, is the practice of tweaking medicine dosages for patients based on their response to a particular dosage. RPM is ideal for this task. Patients can use wireless devices to measure health metrics, and clinicians can review the data to determine medication tolerances and adjust dosages. A study conducted by researchers at UC Davis Medical Center, in which the effectiveness of remote medication management for cardiovascular patients was measured against traditional care methods, found that remote monitoring and titration has the potential to enhance patient care for specific types of patients.
  
  
• Remote rehabilitation
  
  RPM for physical rehabilitation often takes place through movement- and exercise-tracking apps, Bluetooth-connected scales, and wearable devices such as smartwatches, according to the US Health Resources and Services Administration. Some rehabilitation sessions take place over video calls, allowing therapists to monitor in real time a patient’s ability to correctly perform the exercises. Remote rehabilitation is ideal for patients unable to visit a therapy clinic.
  
  
• Pulmonary management
  
  Pulse oximeters allow patients to report on their oxygen saturation levels and heart rate from home. Such regular measurements are particularly important during respiratory viral infection outbreaks such as COVID-19 and influenza, as well as for individuals with COPD and other chronic diseases. New approaches outlined in research from McGill University indicate that biometric wearables, which allow for nearly continuous data collection, will be particularly helpful in treating children, who can’t always easily use devices designed for adults.
  
  
• Hypertension management
  
  Patients with hypertension, or high blood pressure, are using RPM devices such as weight scales and blood pressure cuffs to send vital signs directly to their care provider. A recent study by a team at Mass General Brigham’s Accelerator for Clinical Transformation found that remote monitoring can lead to significantly lower blood pressure and cholesterol levels. During the study, apps allowed staff to handle a large number of patients efficiently, and researchers developed specific clinical protocols that empowered pharmacists to prescribe medications directly to patients, further streamlining the system.

Considerations for Choosing a Remote Patient Monitoring System

RPM development and implementation guidelines published by Harvard Business Review stress that, for remote monitoring programs to work, the technology must be easy for clinicians and patients to use and easy to integrate into existing clinical workflows. Read on for more on these and other considerations.

• Monitoring requirements
  
  For starters, RPM devices must adhere to the FDA’s definition of a medical device. Furthermore, data generated by these devices must be uploaded to a secure location for analysis by clinicians, and that data must be collected for at least 16 out of 30 days, according to the US Health Resources and Services Administration. Monitoring services may be provided by auxiliary personnel as long as they’re under the supervision of the primary care provider.
  
  
• User-friendliness
  
  RPM systems work only if patients use them. Although some devices require very little action on the part of the patient—for example, wearable devices and wireless scales—others require the patient to take measurements on a regular cadence, following steps that can initially seem complicated. The “bring your own device” or smartphone app model is built on the idea that patients will feel most comfortable with technology they’re already using for other purposes. Even with more complex monitoring devices, care team members and patients can work together to develop the skills and attitude needed to succeed.
  
  
• Data security and privacy
  
  Health organizations need to prioritize RPM devices and processes that put a premium on the security and privacy of patient data, storing it in systems that allow access only to the people who need to view it. Bad actors not only can steal patient data, but they can also disrupt monitoring activities and spread malware or ransomware to provider systems.
  
  
• Integration capabilities
  
  According to the latest HealthIT.gov data, as of 2021, 78% of office-based physicians and 96% of nonfederal acute care hospitals had adopted a certified EHR. As a result, at least in theory, remote care services can be integrated into patient records so clinicians can obtain continuous health status data, patients can provide that data without having to make frequent office or lab visits, and clinicians can better coordinate care across multiple providers. The biggest challenge is the multiple formats of patient data that must be integrated into the existing software environment. Organizations need to prioritize EHR vendors that comply with the Fast Healthcare Interoperability Resources (FHIR) standard, which helps ensure that patient data is consistently shared across systems using various forms of exchange protocols.
  
  
• Available training/assistance
  
  RPM system vendors all provide some level of customer support, but the quality of that support varies. Look for vendors that provide 24/7 support, assign a specific account manager, and give the people responsible for managing the devices and showing patients how to use them sufficient training and ongoing support.

Monitor Care from Anywhere with Oracle Health

Health organizations need to invest in RPM capabilities as part of their comprehensive value-based care programs. Systems need to be easy to use and provide clinicians with actionable, real-time data that’s integrated into a patient’s health record. Oracle’s virtual care solutions help health organizations care for patients wherever they are, gather healthcare data from multiple sources, and measure care quality across multiple patient populations.

Oracle can also help with one of the biggest issues with RPM: the sheer volume of data and the high degree of data “noise.” For example, a continuous glucose monitor sending blood sugar readings every 4 hours produces six data points in 24 hours. Oracle’s AI capabilities can help providers cut through the data clutter and get at only the crucial information.

Remote Patient Monitoring FAQs

Does telehealth include remote patient monitoring?
Yes, remote patient monitoring is a subset of telehealth, defined by the US Health Resources and Services Administration as “the use of electronic information and telecommunication technologies to support long-distance clinical healthcare, patient and professional health-related education, health administration, and public health.”

Is remote patient monitoring secure?
The security of RPM devices and processes depends on the system provider and the healthcare organizations using them. To help ensure secure remote patient monitoring, health organizations are implementing cloud-based systems that help defend against cyberattacks and data theft and make patient data accessible only to those people who need to view it.

How does remote patient monitoring benefit healthcare providers?
Remote patient monitoring helps healthcare providers improve the diagnosis and treatment of patients, regularly engage with those patients, and continuously collect data to gain better visibility into health trends.