Remote Physiological Monitoring (RPM ) vs Remote Therapeutic Monitoring (RTM)

By tomeronen

Written by Dr. Lisa Palmerino PT, DPT

What You Need To Know: The Difference Between RPM and RTM Devices

There has been rapid digital transformation of the healthcare industry, most recently accelerated by the COVID-19 pandemic and the need for innovation to continue delivering health services to patients. Many healthcare systems and facilities are now turning to remote physiological monitoring (RPM), otherwise known as remote patient monitoring, and remote therapeutic monitoring (RTM)- tools that help improve facility, provider and patient outcomes.

Simply put, RPM is digital technology used to monitor and capture patients’ objective health data via technology provided by a physician, physician assistant (PA) or a nurse practitioner (NP) to monitor and detect health status outside of scheduled appointment times. Contrarily, RTM technology can be used in healthcare therapeutic services by physical therapists (PT), occupational therapists (OT) and speech language pathologists (SLP) to further analyze treatment response, therapy progression and compliance to a plan of care (POC) outside of scheduled therapy sessions. Therefore, there can be crossover between RPM and RTM, but the 3 most distinguishable differences are1,2:

  1. The provider and their scope of practice when prescribing use of a specific technology, as outlined above.
  2. The purpose of its use as physiologic (RPM) or therapeutic (RTM) data, respectfully.
  3. The ability to capture patient self-reported, subjective data with RTM services.

The popularity of these remote monitoring services was already growing rapidly even prior to the COVID-19 pandemic, but it increased significantly in response to the need for more virtual care options and even more so recently due to the support of Centers for Medicare and Medicaid Services (CMS) via established reimbursement for these services. The establishment of RTM CPT codes took effect on January 1st, 2022.2

These technologies allow clinicians to assess data collected remotely whether once a day, hourly, or on a weekly basis, etc depending on the patient’s specific condition. Both RPM and RTM devices can help patients become more self aware while gaining greater understanding of their health. Both RPM and RTM also permit data and patient driven information that can enhance decision making by clinicians and subsequently patient outcomes.

Let’s Dive Deeper: Examples of RPM and RTM Devices

The wearables and other devices used for RPM must all be able to transmit the patient’s data to the health care provider and that usually involves a dedicated mobile app. The most common technology used to transmit information from the RPM device to the smartphone is Bluetooth Low Energy (BLE). You may already be familiar with some methods of RPM and not even realize it. Some examples of RPM devices are 3,4,5:

  • Smart watches. A wearable solution with artificial intelligence (AI) integration and various monitors and sensors to generate data regarding heart rate variability, ECG, SpO2, blood pressure, fall or emergency alerts and more.
  • Digital blood pressure cuffs. An inflatable cuff that permits measuring blood pressure responses throughout the day to inform cardiovascular health or diseases.
    • Blood glucose monitors. A digital device that takes a minimal sample of blood to measure blood sugar levels, which can be monitored throughout the day which is necessary for patients with diabetes (type 1 and 2). Ongoing monitoring allows health care providers to assess the impact of medication(s), diets, or exercise on blood glucose levels.
  • Electronic thermometers. Measuring body temperature to compare a patients’ data to normative values to inform symptomatology, or lack thereof, and appropriate care response.
  • Connected or smart scales. Measuring body weight; this may commonly be used for patients prescribed weight management or for individuals’ with conditions such as congestive heart failure or lymphedema as compromised cardiovascular and lymphatic systems, respectfully, can cause fluctuations in fluid retention and subsequently weight.
  • Holter monitors. A wearable device, worn continuously for a specific period of time, which measures ongoing ECG readings to assess for possible heart arrhythmias.
  • Continuous Positive Airway Pressure (CPAP) machines. These devices are worn to distribute continuous oxygenated airflow to individuals who require it to address conditions like obstructive sleep apnea (OSA) and can generate data that helps monitor respiratory status for patients.

Again, these devices and their data would help a physician, PA or NP further assess and manage various acute or chronic medical conditions.

RTM is similar to RPM, with the main difference: RTM involves the management of patients that use medical devices which collect therapeutic data. Essentially, RTM is any type of information collected by a medical device and software measuring metrics such as therapy adherence, treatment response, respiratory system status and/or musculoskeletal system status.

Some examples of RTM devices currently available are1,6,7,8:

  • Smart watches. Wearable solutions with artificial intelligence to display data in a secure, web-based portal monitoring health variables such as: activity volume, HEP compliance, pain levels, mobility assessment, fall risk, sleep hygiene, oxygen saturation, and cognitive analysis. The data transmission, incorporated with evidence-based algorithms informed by objective and subjective reports, allows ongoing development and assessment of patient health trends and insights that can bridge gaps in the patient care experience.
  • Mobile Apps. Applications that require the user to operate a tablet, smartphone, computer, etc which the patient must own to gain access to the app features. These programs typically depend on high patient accountability for compliance to yield desired patient outcomes.

Advancing Healthcare

Technology-based healthcare delivery, such as telehealth services, have proven benefits when used, particularly as a part of care options offered to older adult patient populations.9 RPM and RTM have a growing body of evidence, more clinical experts using these services to enhance patient care and a large senior patient pool who are using these devices to improve their quality of life. RPM services yield benefits salient to patients and healthcare workers, some including10:

  1. Reducing emergency room (ER) visits and re-admissions
  2. Monitoring vital signs more frequently which has the potential to decrease mortality rates of high-risk or more medically complex patients
  3. Healing at home vs expensive facilities
  4. Fall alert detection

While RTM services are “newer” in healthcare delivery, in the sense that they are now reimbursable by CMS as of the beginning of this year with subsequent early stages of deployment in many settings, there are technological solutions already out there that have been used successfully and continue to be developed. Some solutions are supported by clinical expertise and ongoing research, all with patient values in mind. Here are some more reasons why RTM technological innovation can provide benefit:

  1. Improve clinician efficiency, their care provider experience and support of their professional autonomy
  2. Enhance patient POC compliance
  3. Facilitate better outcomes: goal achievement and patient safety
  4. Increase patient self awareness and engagement to promote higher quality of life
  5. Provide healthcare facilities with financial ROI and innovative resources

Learn more about the options available to you, including if it is FDA approved, and let’s utilize these technologies to change healthcare for the better.

References

  1. Owlytics H. Owlytics Healthcare. https://www.owlytics.com/. Published March 14, 2022. Accessed May 26, 2022.
  2. Centers for Medicare and Medicaid Services Dof Hand HS, ed. Transmittal 11118. Change Request 12446. Pub 100-04 Medicare Claims Processing – CMS Manual System. https://www.aapc.com/codes/exclusives/transmittals/2022-annual-update-to-the-therapy-code-list-6681. Published November 10, 2021. Accessed May 3, 2022.
  3. Bashi N, Karunanithi M, Fatehi F, Ding H, Walters D. Remote Monitoring of Patients With Heart Failure: An Overview of Systematic Reviews. J Med Internet Res. 2017 Jan 20;19(1):e18. doi: 10.2196/jmir.6571. PMID: 28108430; PMCID: PMC5291866.
  4. Salehi S, Olyaeemanesh A, Mobinizadeh M, Nasli-Esfahani E, Riazi H. Assessment of remote patient monitoring (RPM) systems for patients with type 2 diabetes: a systematic review and meta-analysis. J Diabetes Metab Disord. 2020 Jan 10;19(1):115-127. doi: 10.1007/s40200-019-00482-3. PMID: 32550161; PMCID: PMC7270436.
  5. Staff MC. Polysomnography (Sleep Study). Mayo Clinic. https://www.mayoclinic.org/tests-procedures/polysomnography/about/pac-20394877#:~:text=During%20the%20study%2C%20the%20technologist,one%20type%20of%20PAP%20machine. Published December 1, 2020. Accessed May 26, 2022.
  6. Farivar S, Abouzahra M, Ghasemaghaei M. Wearable device adoption among older adults: A mixed-methods study. Int J Inf Manage. 2020;55:102209. doi:10.1016/j.ijinfomgt.2020.102209
  7. Majumder S, Mondal T, Deen MJ. Wearable Sensors for Remote Health Monitoring. Sensors (Basel). 2017 Jan 12;17(1):130. doi: 10.3390/s17010130. PMID: 28085085; PMCID: PMC5298703.
  8. Moore K, O’Shea E, Kenny L, et al. Older Adults’ Experiences With Using Wearable Devices: Qualitative Systematic Review and Meta-synthesis. JMIR Mhealth Uhealth. 2021;9(6):e23832. Published 2021 Jun 3. doi:10.2196/23832
  9. Batsis JA, DiMilia PR, Seo LM, et al. Effectiveness of Ambulatory Telemedicine Care in Older Adults: A Systematic Review. J Am Geriatr Soc. 2019;67(8):1737-1749. doi:10.1111/jgs.15959
  10. Farias FAC, Dagostini CM, Bicca YA, Falavigna VF, Falavigna A. Remote Patient Monitoring: A Systematic Review. Telemed J E Health. 2020;26(5):576-583. doi:10.1089/tmj.2019.0066
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