Remote Therapeutic Monitoring in Rheumatic and Musculoskeletal Diseases: Opportunities and Implementation

Main Article Content

W. Benjamin Nowell, PhD, MSW Jeffrey R. Curtis, MD, MS, MPH

Abstract

Therapeutic Monitoring (RTM) is a new program in the United States that began in 2022 allowing electronic patient-reported outcomes (ePRO) and other patient-generated data to be reviewed by clinical staff between visits so that patients can receive clinical attention as needed. Remote Therapeutic Monitoring simultaneously enhances the capacity to generate prospective longitudinal data that may be useful for secondary research purposes. As many governmental and private insurance programs in the United States now provide reimbursement for Remote Therapeutic Monitoring, increasing numbers of rheumatologists may be incentivized to provide this service for their patient populations. Launched in 2015, the ArthritisPower® Research Registry and associated mobile and desktop application, registered with the Food & Drug Administration (FDA) as a Class I medical device, enables patients to track their disease across dozens of domains and to securely participate in voluntary research studies. ArthritisPower, in partnership with Illumination Health, has developed infrastructure and a clinical workflow for Remote Therapeutic Monitoring that will help rheumatologists more closely track their patients’ disease activity and flares, identify primary non-adherence, record changes in key health domains (e.g. fatigue, pain, physical function, mental health) and meet the needs for other data elements important for clinical care identified by individual providers. Ultimately, the approach to use digital health tools between visits seeks to improve clinical outcomes for patients with rheumatic and musculoskeletal diseases. This editorial review discusses the evolution of remote monitoring in rheumatologic care, describes the opportunities for physician reimbursement as of 2023, and provides a suggested workflow in order to establish Remote Therapeutic Monitoring within rheumatology practices.

Keywords: Rheumatoid Arthritis, Psoriatic Arthritis, Ankylosing Spondylitis, Telemedicine, Patient-Reported Outcomes

Article Details

How to Cite
NOWELL, W. Benjamin; CURTIS, Jeffrey R.. Remote Therapeutic Monitoring in Rheumatic and Musculoskeletal Diseases: Opportunities and Implementation. Medical Research Archives, [S.l.], v. 11, n. 7.2, aug. 2023. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/3957>. Date accessed: 22 dec. 2024. doi: https://doi.org/10.18103/mra.v11i7.2.3957.
Section
Research Articles

References

1. Marwaha JS, Raza MM, Kvedar JC. The digital transformation of surgery. npj Digital Medicine. 2023/05/31 2023;6(1):103. doi:10.1038/s41746-023-00846-3
2. GlobeNewswire. G Medical Innovations and MiCare Path Announce Joint Collaboration to Provide Innovative Remote Patient Monitoring Solutions Globally. 2023.
3. Bolam SM, Batinica B, Yeung TC, et al. Remote Patient Monitoring with Wearable Sensors Following Knee Arthroplasty. Sensors (Basel). Jul 29 2021;21(15)doi:10.3390/s21155143
4. Weinberg M, Danoff JR, Scuderi GR. Remote Patient Monitoring Following Total Joint Arthroplasty. Orthop Clin North Am. Apr 2023;54(2):161-168. doi:10.1016/j.ocl.2022.11.002
5. Curtis JR, Willig J. Uptake of Remote Physiologic Monitoring in the US Medicare Program: A Serial Cross-sectional Analysis. JMIR Mhealth Uhealth. 2023:e46046.
6. Tang M, Mehrotra A, Stern AD. Rapid Growth Of Remote Patient Monitoring Is Driven By A Small Number Of Primary Care Providers. Health Aff (Millwood). Sep 2022;41(9):1248-1254. doi:10.1377/hlthaff.2021.02026
7. CCHP. State Telehealth Policies Remote Patient Monitoring. Updated 2/26/2023. Accessed 4/3/2023, https://www.cchpca.org/topic/remote-patient-monitoring/
8. Kvedar JC, Mittermaier M, Pritzker J. The industry impact of the American Medical Association’s Digital Medicine Payment Advisory Group (DMPAG). npj Digital Medicine. 2022/12/24 2022;5(1):193. doi:10.1038/s41746-022-00743-1
9. Tang M, Nakamoto CH, Stern AD, Mehrotra A. Trends in Remote Patient Monitoring Use in Traditional Medicare. JAMA Internal Medicine. 2022;182(9):1005-1006. doi:10.1001/jamainternmed.2022.3043
10. Melchionna M. Medicare Remote Patient Monitoring Use Shot Up During Pandemic. https://mhealthintelligence.com/news/medicare-remote-patient-monitoring-use-shot-up-during-pandemic
11. Curtis J, Willig J. The Promise for Remote Patient Monitoring to Transform Outpatient Care. JMIR. 2023;doi:In press
12. Medicare Program; CY 2022 Payment Policies under the Physician Fee Schedule and Other Changes to Part B Payment Policies; Medicare Shared Savings Program Requirements; Provider Enrollment Regulation Updates; and Provider and Supplier Prepayment and Post-payment Medical Review Requirements 42 CFR Parts 403, 405, 410, 411, 414, 415, 423, 424, and 425 (2022).
13. Services UDoHaH. Telehealth policy changes after the COVID-19 public health emergency. https://telehealth.hhs.gov/providers/policy-changes-during-the-covid-19-public-health-emergency/policy-changes-after-the-covid-19-public-health-emergency
14. Bestsennyy O, Gilbert G, Harris A, Rost J. Telehealth: A quarter-trillion-dollar post-COVID-19 reality? https://www.mckinsey.com/industries/healthcare/our-insights/telehealth-a-quarter-trillion-dollar-post-covid-19-reality
15. Danila MI, Gavigan K, Rivera E, et al. Patient Perceptions and Preferences Regarding Telemedicine for Autoimmune Rheumatic Diseases Care During the COVID-19 Pandemic. Arthritis Care Res (Hoboken). Jul 2022;74(7):1049-1057. doi:10.1002/acr.24860
16. Jackson LE, Edgil TA, Hill B, et al. Telemedicine in rheumatology care: A systematic review. Semin Arthritis Rheum. Oct 2022;56:152045. doi:10.1016/j.semarthrit.2022.152045
17. Rheumatology ACo. 2020 Rheumatic Disease Patient Survey. 2020.
18. Watrous D, Parris G, Reddy P, et al. Impact of COVID19 on Missed/Cancelled Rheumatology Office Visits and Parenteral Immunosuppressive Medications. Arthritis Rheumatol; 2020:
19. Pritchett JC, Patt D, Thanarajasingam G, Schuster A, Snyder C. Patient-Reported Outcomes, Digital Health, and the Quest to Improve Health Equity. Am Soc Clin Oncol Educ Book. Jun 2023;43:e390678. doi:10.1200/edbk_390678
20. Abbasi-Feinberg F. Telemedicine Coding and Reimbursement - Current and Future Trends. Sleep Med Clin. Sep 2020;15(3):417-429. doi:10.1016/j.jsmc.2020.06.002
21. Seppen B, Wiegel J, Ter Wee MM, et al. Smartphone-Assisted Patient-Initiated Care Versus Usual Care in Patients With Rheumatoid Arthritis and Low Disease Activity: A Randomized Controlled Trial. Arthritis Rheumatol. Nov 2022;74(11):1737-1745. doi:10.1002/art.42292
22. Leo DG, Buckley BJR, Chowdhury M, et al. Interactive Remote Patient Monitoring Devices for Managing Chronic Health Conditions: Systematic Review and Meta-analysis. J Med Internet Res. Nov 3 2022;24(11):e35508. doi:10.2196/35508
23. Taylor ML, Thomas EE, Snoswell CL, Smith AC, Caffery LJ. Does remote patient monitoring reduce acute care use? A systematic review. BMJ Open. Mar 2 2021;11(3):e040232. doi:10.1136/bmjopen-2020-040232
24. Marques A, Bosch P, de Thurah A, et al. Effectiveness of remote care interventions: a systematic review informing the 2022 EULAR Points to Consider for remote care in rheumatic and musculoskeletal diseases. RMD Open. 2022;8(1):e002290. doi:10.1136/rmdopen-2022-002290
25. Austin L, Sharp CA, van der Veer SN, et al. Providing ‘the bigger picture’: benefits and feasibility of integrating remote monitoring from smartphones into the electronic health record: Findings from the Remote Monitoring of Rheumatoid Arthritis (REMORA) study. Rheumatology. 2019;59(2):367-378. doi:10.1093/rheumatology/kez207
26. Nowell W, Curtis JR, Zhao H, et al. Participant Engagement and Adherence in an ArthritisPower Real-World Study to Capture Smartwatch and Patient-Reported Outcome Data Among Rheumatoid Arthritis Patients. Arthritis Rheumatol; 2020:
27. Casale PN, Vyavahare M, Coyne S, et al. The Promise of Remote Patient Monitoring: Lessons Learned During the COVID-19 Surge in New York City. Am J Med Qual. May-Jun 01 2021;36(3):139-144. doi:10.1097/01.JMQ.0000741968.61211.2b
28. Arumalla N, Chan CKD, Gibson M, et al. The clinical impact of electronic patient-reported outcome measures in the remote monitoring of inflammatory arthritis: a systematic review and meta-analysis. Arthritis & Rheumatology. n/a(n/a)doi:https://doi.org/10.1002/art.42559
29. Song Y, Bernard L, Jorgensen C, Dusfour G, Pers YM. The Challenges of Telemedicine in Rheumatology. Front Med (Lausanne). 2021;8:746219. doi:10.3389/fmed.2021.746219
30. Nowell WB, Curtis D, Curtis JR. ArthritisPower Reflects Optimal Characteristics of Apps for Rheumatoid Arthritis. J Clin Rheumatol. Mar 1 2021;27(2):e44-e45. doi:10.1097/rhu.0000000000001223
31. Nowell WB, Curtis D, Thai M, et al. Digital Interventions to Build a Patient Registry for Rheumatology Research. Rheum Dis Clin North Am. May 2019;45(2):173-186. doi:10.1016/j.rdc.2019.01.009
32. Nowell WB, Merkel PA, McBurney RN, et al. Patient-Powered Research Networks of the Autoimmune Research Collaborative: Rationale, Capacity, and Future Directions. The Patient - Patient-Centered Outcomes Research. 2021/04/27 2021;doi:10.1007/s40271-021-00515-1
33. Sweeney MM, Holtyn AF, Stitzer ML, Gastfriend DR. Practical Technology for Expanding and Improving Substance Use Disorder Treatment: Telehealth, Remote Monitoring, and Digital Health Interventions. Psychiatr Clin North Am. Sep 2022;45(3):515-528. doi:10.1016/j.psc.2022.05.006
34. Shah SS, Safa A, Johal K, Obika D, Valentine S. A prospective observational real world feasibility study assessing the role of app-based remote patient monitoring in reducing primary care clinician workload during the COVID pandemic. BMC Fam Pract. Dec 16 2021;22(1):248. doi:10.1186/s12875-021-01594-7