How can we bring care to patients without bringing patients to hospital?
Patients’ outcomes monitoring and reporting improvement solutions are a great unmet need in current healthcare systems. Despite the efforts of both patients and physicians, symptoms associated with the disease and with therapy itself (most often chemotherapy) are poorly controlled.
Current symptom assessment mechanisms rely on patients recognizing that symptoms are severe enough to warrant reporting to their physicians. Uncertainty, delayed reporting, and inability to access 24-hour services frequently lead to complications not being recognized promptly enough, placing patients’ safety at risk, often leading to emergency hospitalizations. In addition to that, patients from remote areas need to travel for quite some time to get to the specialized healthcare provider, which might not always be possible or leads to decreased sensitivity for adverse events – they would travel only for the really serious one or might travel late after the onset.
The vision of the challenge is the following:
- Help doctors to efficiently manage monitoring and optimization of the treatment for patients through regular remote feedback.
- Support patients through adoption of new technologies on their way of fighting serious chronic diseases, such as cancer, and increasing their likelihood of positive treatment outcome
- Real World Data generation which can be used for secondary use to contribute into value-based healthcare worldwide
The vision for optimal patient care is to provide the best care possible, regardless of their location or resources.
Thanks to innovative solutions, patients can provide regular updates, anytime about their treatment outcomes and symptoms and share them with doctors, in between face-to-face visits, from their home. This essential information can dramatically improve their treatment outcomes and prolong survival rate.
Healthcare professionals can receive and access their patients’ treatment outcomes data anytime, within the hospital infrastructure, in order to make better and faster decisions on patient treatment in order to increase positive treatment outcomes rates as well as optimizing the resources management around the patient treatment.
Dealing with a chronic disease and tough treatment procedures can be very challenging for many patients as it can have a major impact on their overall quality of life. Despite guidance for patients and professionals on managing powerful and demanding therapies, such as chemotherapy, physicians are often unable to properly monitor and control the progress of patients and the impact of the disease without frequent visits or even hospitalization. As a result, undertreatment of symptoms results in poorer adherence to treatment, impaired quality of life, increased health service use, and even increased mortality amongst patients.
Current symptom assessment mechanisms rely on patients recognizing that symptoms are severe enough to warrant reporting or to contact and visit their doctor. Uncertainty, delayed reporting, and inability to access 24 hour services frequently lead to toxicities not being recognised sufficiently quickly, placing patients’ safety at risk. Moreover, the overall impact on the quality of life of patients can be neglected in the whole treatment and disease management process.
Innovative solutions are needed to expedite this process to improve patients’ outcomes and to reduce costs. These seem to be beneficial for people receiving demanding therapy, as they can circumnavigate the need for retrospective assessment during their doctor visit – a process believed to “provide a weaker insight into actual symptom burden” as a result of recall bias. Such systems also enable patients’ data to be relayed to clinicians within minutes, enabling proactive symptom management. Previous research on remote monitoring systems in the chemotherapy context highlights their benefits for health-related quality of life, symptom alleviation, avoiding unscheduled hospital admissions, survival, and ultimately greater cost effectiveness (1).
Multiple standardized Patient-reported outcome measures (PROMs) tools have been developed and validated as a means of quantitatively and qualitatively assessing mental, social, and physical function of patients (2). With PROMs, patients answer a series of expertly predefined questions about the most recent impacts of their disease and therapy on the overall quality of life. The PROMs can be reported at different time rates and with different focus on specific areas depending on the disease and the demographics of the patients. This data can be evaluated by clinicians to better assess the current state of health and quality of life of patients, aiding their clinical decision making.
However, the adoption and scalability of PROMs systems is limited heavily due to the challenge of workflow and IT integration of the solution into different infrastructure set up in hospitals, as well as low motivation from the side of hospital physicians and administration to integrate and maintain the solution. This might be due to technical complexity of implementation, lower level of digital infrastructure and digital awareness among medical specialists, and lack of resources (time & HR) to ensure proper implementation and usage of PROMs.
Moreover, the reporting solutions need to be used and deployed in such a way that patients feel comfortable with using them, and are motivated and to provide regular and accurate inputs.
Remote patient monitoring could offer a huge benefit when it comes to patient management and treatment outcome improvement. Patients can report their outcomes on a more frequent basis. Therefore, the doctors can react more effectively when they notice patients developing more severe symptoms and prolong the survival rate of the patient. This could not only decrease the urgent emergency visits of patients, but also optimize the patient management for treating physicians, so they can fully focus on patients who need the most urgent care.
For example, remote monitoring of breast cancer patients is well set up and an essential step for better personalized treatment.
The solutions should focus on:
- Breast cancer patients, with a potential to scale to other therapeutic areas, starting from oncology
- Digital innovation and compliance of patient remote monitoring compared to the current standard of care
- Smoother and more effective patient management from the perspective of doctors by enabling them to collect required information and PROMs remotely and more regularly
- Creating an added value and motivation for patients to use such solutions and to better manage their chronic disease
- Compatibility with the Real-world data generation for institutions such as NCZI, to allow for evaluation of value-based healthcare
- Compatible with local HC (non)digital solutions at the point of care
Solutions should avoid (non-targets):
- Duplication of current system setting
- Unjustified integration or use of non-medical devices, such as smart bracelets
- International Healthcare Guidelines ESMO
- Approved and published healthcare guidelines in Slovakia
- The ICHOM Set of Patient-Centered Outcome Measures
- The Most Advanced Remote Patient Monitoring Platform
- Impact of remote patient monitoring on clinical outcomes
- PROMs studies: