Research Spotlight: Hospital at Home and The Next Frontier of Remote Patient Monitoring

Jared Conley, MD, PhD, MPH, an Assistant Professor at Harvard Medical School and emergency physician at Mass General Hospital, is the corresponding author of a viewpoint article in the Journal of Medical Internet Research, “The Next Frontier of Remote Patient Monitoring: Hospital at Home.”

What Problem Were You Investigating?

We wanted to answer the question, how can remote patient monitoring be better employed to enable the expansion of the hospital-at-home (HaH) model to benefit more patients seeking to heal in the comfort of their homes?

Technological advancements have transformed many industries, allowing services and products to be increasingly accessible and ‘on-demand’ for consumers at home. Healthcare is undergoing a similar change. This article outlines how the latest technology is enabling care for patients needing hospital-level care to be delivered in the comfort and convenience of their homes.

What Was Your Approach?

We reviewed the existing literature on remote patient monitoring and data on the impact of continuous vital sign monitoring in hospital-based settings as well as reflected on MGB’s Home Hospital experience to identify potential opportunities for RPM to support HaH.

Remote patient monitoring (RPM) has shown promise in aiding safe and efficient remote care for chronic conditions; however, its use remains more limited within the HaH model of care despite a significant opportunity to increase patient eligibility, improve safety, and decrease costs.

We have a significant opportunity right now to expand HaH patient eligibility and safety, and increase operational efficiency by utilizing remote patient monitoring through wearable devices that measure vital signs (heart rate, oxygen level, etc.), detect falls and monitor continuous EKG. This can enable us as physicians to care for patients with a better pulse on their health status and ensure such hospital-level care can still be performed safely in the comfort and convenience of the patient's home.

What Are the Next Steps?

We want to further develop RPM for HaH at Mass General Brigham, as we seek to build a 200-bed virtual at-home hospital. We will also be discussing the topic at Tech Summit for hospital at home in Barcelona on March 30, 2023.

For the larger HaH ecosystem, the focus should be directed toward several key areas for RPM to achieve its potential to strengthen access to HaH services and further enhance the quality of HaH care.

For RPM to deliver optimal value, robust research is needed to determine which RPM approach, if any, best serves a given HaH patient, as limited in-hospital research exists to inform monitoring modality and frequency. Second, to support RPM implementation, early adopters should be encouraged to openly share RPM best practices via forums such as the Hospital at Home Users Group and the World Hospital at Home Community. Additionally, clinicians and software engineers should continue to work together where RPM is implemented to ensure the data architecture and RPM alert pathways achieve safe and actionable physiologic monitoring while minimizing false alerts.

Ultimately, RPM for HaH is in its infancy in achieving its potential to advance the HaH model of care; further research and experience that inform operational and technical as well as policy considerations are needed.

Work Cited:

Whitehead, D., & Conley, J. (2023). The Next Frontier of Remote Patient Monitoring: Hospital at Home. Journal of medical Internet research, 25, e42335.

About the Massachusetts General Hospital

Massachusetts General Hospital, founded in 1811, is the original and largest teaching hospital of Harvard Medical School. The Mass General Research Institute conducts the largest hospital-based research program in the nation, with annual research operations of more than $1 billion and comprises more than 9,500 researchers working across more than 30 institutes, centers and departments. In July 2022, Mass General was named #8 in the U.S. News & World Report list of "America’s Best Hospitals." MGH is a founding member of the Mass General Brigham healthcare system.