By Brit Cooper-Jones
In the wake of the COVID-19 pandemic, there has been an interest in increasing the provision of virtual care across the country. One example of virtual care is the use of remote monitoring programs and devices for chronic cardiac conditions, such as heart failure, high blood pressure, atrial fibrillation, and cardiac rehabilitation.
What exactly are “remote monitoring programs”? They are programs delivered through technology and/or telecommunication that help to monitor heart-related health data. They may involve interactive components with care providers (like a family doctor or heart specialist) or be designed more for education and self-monitoring purposes. Examples could range from collecting physiological measurements such as blood pressure or heart rate readings at home, to using any of these measurements (plus or minus telehealth visits) to offer increased care, oversight of, or education about a chronic heart condition without always having to see the doctor face-to-face.
The literature supports remote monitoring programs for chronic heart conditions as being generally effective and well-received. However, there are few details in the literature about what the actual mechanisms of these programs are, for whom they are best suited (and most effective), and what it is about various program offerings that make them more or less successful. Additionally, the cost-effectiveness of remote monitoring programs is largely unknown.
But it turns out that the biggest question of interest for stakeholders and health care decision-makers at this time is less about the clinical effectiveness and cost-effectiveness of remote monitoring programs, and more about gaining a greater understanding into program mechanisms and implementation considerations.
Responding to this need, CADTH – an independent not-for-profit organization that reviews the evidence on various health-related topics – conducted an Environmental Scan that summarized the current state of remote monitoring programs across Canada. Remote monitoring programs presently exist in BC, Ontario, New Brunswick, PEI, and Newfoundland and Labrador. The Environmental Scan reviews the details of these programs (as well as programs currently in development), in addition to summarizing operational considerations reported at the site level (perceived barriers and facilitators).
Due to the high level of interest in this topic, the Environmental Scan was only a first step, and CADTH followed it up with a full Health Technology Assessment (HTA). The HTA included three sections: a realist review looking at program mechanisms, a perspectives and experiences review, and an ethics review. CADTH also engaged patients and caregivers directly to gain greater insight into how these programs work in their daily lives and the aspects and features that were seen as most important.
The Health Technology Expert Review Panel (HTERP) then reviewed all of the evidence and developed recommendations regarding key implementation considerations for remote monitoring programs. These recommendations were divided into five domains: patient and caregiver considerations, provider considerations, data and privacy, digital equity, and evaluation.
On the patient and caregiver front, the need for functional and easy-to-use technologies was a priority. Additionally, since technological literacy could be a barrier, the availability of technical support was a facilitator. The ability to address the needs of caregivers was highlighted, given that caregiver support could be either a barrier or a facilitator to uptake. And finally, due to the lack of evidence specific to potentially higher-needs populations (e.g., those in rural/remote settings, Indigenous peoples, people of low socioeconomic status, etc.), HTERP recommended consulting these groups to better understand their needs and priorities prior to implementing a remote monitoring program.
With regards to providers, HTERP recommended that remote monitoring programs, if implemented, be integrated into clinical practice guidelines and the clinical care pathway, as well as into electronic medical records. HTERP noted the importance of considering the potential increase in workload for care providers associated with remote monitoring programs, and the need to consider appropriate remuneration (as well as policies for patients accessing care outside of their jurisdiction).
On the data and privacy front, protecting consumers from third party use of data was key, in addition to considering how and where data is transmitted and stored. For digital equity, HTERP noted that it is important that remote monitoring programs do not create or exacerbate existing disparities in care. They highlighted factors such as the potential economic burden of bring-your-own-device models as well as the importance of not foregoing in-person care for higher-needs groups who may benefit. Finally, HTERP recommended that remote monitoring programs include an evaluation component to ensure program aims are met, and to help in assessing the cost-effectiveness of such programs moving forward.
More detail on each of HTERP’s recommendations for the successful implementation of remote monitoring programs can be found in the full report:
Brit Cooper-Jones is a knowledge mobilization officer at CADTH.
