Jared Conley, MD, PhD, MPH

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 hospital at home (HaH) model of care despite a significant opportunity to increase patient eligibility, improve safety, and decrease costs. HaH could achieve these goals by further adopting the 3 primary modalities of RPM (ie, vital sign, continuous single-lead electrocardiogram, and fall monitoring). With only 2 in-person vital sign… Show more

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 hospital at home (HaH) model of care despite a significant opportunity to increase patient eligibility, improve safety, and decrease costs. HaH could achieve these goals by further adopting the 3 primary modalities of RPM (ie, vital sign, continuous single-lead electrocardiogram, and fall monitoring). With only 2 in-person vital sign checks required per day, HaH patient eligibility is currently often limited to lower-acuity cases. The use of vital sign RPM within HaH could better match the standard clinical practice of vital sign checks every 4-8 hours and enable safe care for appropriate moderate-acuity medical and surgical floor-level patients not traditionally enrolled in HaH. Robust, efficient collection of more frequent vital signs via RPM could expand patient eligibility for HaH and create a digital health safety net that enables high quality care. Similarly, our experience at Massachusetts General Hospital has demonstrated that appropriate use of continuous single-lead electrocardiogram RPM can also expand HaH enrollment, particularly for patients with acute decompensated heart failure. Through increasing enrollment of patients in HaH, RPM stands to enable more patients to reap the potential safety benefits of home hospitalization, including decreased rates of delirium and hospital-acquired infections, and better avoid aspects of posthospital syndrome. Furthermore, instituting fall detection RPM allows care teams to further HaH patient safety during their episode of acute care and develop enhanced mitigation strategies to avoid falls post home hospitalization. RPM also has the potential to assist HaH in achieving greater economies of scale and decreasing direct variable costs. By expanding HaH eligibility, RPM could enable HaH programs, which have traditionally operated under capacity… Show less

Since 2016, two hospital at home programs at Mass General Brigham have cared for more than 2,000 patients and have developed significant experience leveraging technology to improve clinical outcomes, operational efficiency, and the care experience for both patients and clinicians. These technologies have spanned from supporting remote visits and facilitating remote patient monitoring to enhancing clinical team coordination and supply chain management. Key lessons have been learned along these… Show more

Since 2016, two hospital at home programs at Mass General Brigham have cared for more than 2,000 patients and have developed significant experience leveraging technology to improve clinical outcomes, operational efficiency, and the care experience for both patients and clinicians. These technologies have spanned from supporting remote visits and facilitating remote patient monitoring to enhancing clinical team coordination and supply chain management. Key lessons have been learned along these verticals, and there have been several important interoperability/integration and health equity implications, as the patient population and technology portfolio have expanded. Early experience points toward the use of these technologies in hospital at home as being safe and acceptable to patients and clinicians, as well as holding significant promise in enhancing clinical resource efficiency and coordination that will be critical to the scaling of acute care delivery in the home. Show less