Remote Health Monitoring Gives Opportunity for Early Medical Intervention

Shyam B. Paryani, MD, MD, MHA, FACRO, FACHE, discusses his upcoming study that investigates the impact of remotely monitoring people who are "well" and not yet "patients" with the hope of preventing illness. Remote monitoring takes a holistic view by integrating the mind-body connection, and uses telehealth interventions to stay in touch with patients. While this technology will be useful for many areas of medicine, Dr Paryani hopes mental health clinicians will be able to gain a better understanding of their patients' sleep patterns, daily mood and anxiety levels, activity levels, and other aspects of health that impact mental health.

In the upcoming part 2, Dr Paryani continues his conversation with Meagan Thistle, associate digital editor, Psych Congress Network, and further explains the connection with telehealth, digital mental health, and clinical intervention to keep patients healthy.

Meagan Thistle, Associate Digital Editor: Hi, Psych Congress Network family. Thank you so much for joining us. Today, we're going to be talking with Dr Shyam Paryani, if you'd like to introduce yourself a little further.

Shyam B. Paryani, MD, MS, MHA, FACRO, FACHE: Great. Thank you, Meagan. I am a radiation oncologist. I've been in practice for over 30 years in North Florida, and in the last 10 years or so, I've been teaching students in oncology as well as in health administration. Currently, I'm the director of the Executive Masters in Health Administration Program at the University of North Florida.

Thistle: Thank you so much for joining us. We're very excited to talk with you today about your upcoming study. If you wouldn't mind, we'll just get started with what initiated you and your colleagues to investigate remote monitoring of patients?

Dr Paryani: Well, I think with COVID, there's been a lot of changes in healthcare. Telehealth has really got to the forefront. We actually did a study that we reported on recently about Medicare and telehealth and that led us to talk about various other alternatives that are being used for healthcare delivery. One of our partners and collaborators is the Mayo Clinic here in Jacksonville.

They have been doing a study on advanced care at home where they've been using monitoring for patients who are inpatients and then transferred to a home setting at an earlier interval, so they can get home earlier, but they have intense monitoring, so they have monitoring on all the vital signs and specific areas depending on their disease, and they also have nurses that come out to the home and pharmacists and drug delivery, so a very advanced level of home health monitoring.

We thought that the other natural extension was, well, why don't we take the opposite extreme? This is the extreme of patients who are really ill. Why don't we take patients who are well? Can we apply home health monitoring to those patients and keep them from getting to the point where they get to the hospital?

There's lots of evidence and data on using remote monitoring on patients for specific conditions, but there's not very many studies that have looked at just monitoring normal patients, or normal people, they're not even patients yet, and they're normal people living in a residential area. Can you monitor them and make a difference in detecting disease early and prevent those diseases? We're going from the whole spectrum of taking care of patients who are ill, now to taking care of people and trying to keep them well before they get to be patients.

Thistle: Right. Well, that is very exciting, and I'm sure our audience is going to be very excited to see this technology, and the study around it. That being said, what do you think are the biggest challenges when you're remotely monitoring patients on either spectrum, whether they're those well patients or those who are directly out of the hospital?

Dr Paryani: Well, I think two major challenges. First is compliance. It's easy, I think, for patients who are in the hospital and tell them, "You can get home early, if you do these things." Most people will be willing to do anything to get out of the hospital because they want to get to the home setting, so they're easy to comply. The second challenge is the sophistication of the technology and using it properly, training people who are perhaps not tech-savvy, or even tech-afraid. You probably have parents and grandparents that are a little reluctant to use those kind of technologies, so you got to kind of have their buy-in to use that technology.

Those are 2 major challenges that they've noticed on the advanced care health home, and we think we've got the same challenges here is really, number one, motivation. Do they have motivation to monitor themselves and keep it up? People say, "Yes, we're going to do it," but like everything else, we get busy, and then don't keep up, so compliance is a very critical issue to do this study properly. To get proper data, we need compliance.

Second is that they're not afraid of technology. The way we're going to hopefully overcome that is have good training and good backup so that they don't feel intimidated by the technology.

Thistle: Amazing. Yeah. I'm imagining my fiercely independent grandmother, trying to learn this. That's really great to hear you'll have that training and support.

Dr Paryani: Yeah, they almost to go back to the ATM. They don't want to use the ATM, they don't want to use iPad for email, you tell them, well, you eventually figured this out, and we can figure it out. The other thing we try to do with remote monitoring is we make it easy. At least on the outpatient side is easier to make it easy because all of this devices now have the capability of Bluetooth or wifi, so basically, the patient doesn't really need to do very much. They just need to wear the device. What we're going to have is a medical-grade Fitbit, which will track them. They have to keep it on, that's all they need to do. If it goes awry, for instance, because we're continuously monitoring, we'll know. We'll send a message or send somebody to take care of that.

All the data is electronically delivered automatically, so they don't need to enter anything in a computer. They don't even need to go a computer. They don't need to have a computer. All they need is the phone. There's actually an app on the phone and the Bluetooth is transferred to the phone. Most people these days have cell phones and the capability of either cellular service or Wi-Fi service. Either one will work to get that data in, so we made it really easy to comply so that even your grandma wouldn't have any problem doing this, and those less reluctance to do that, or my parents, or our family members wouldn't have reluctance do that.

Thistle: Great. You kind of touched on some of it, but maybe we could dive deeper. What do you anticipate will be the greatest benefits of this remote monitoring?

Dr Paryani: I think it's going to vary, Meagan, depending on the patient population we're studying. I think the first population we're going to study is the senior citizen population, i.e. 65 and over. We actually identified a facility, which is great because there are local partners here at Cypress Village. They have an independent living facility where people have moved there, but are independent. They don't require any medical assistance, but they have medical capability available.

They also have assisted care and nursing home facility, so they have all levels of care available to those patients. The other nice thing is they have nurses and doctors on-site, so if even the independent living patients need any kind of medical intervention, they're right there on the same campus, they don't need to leave anywhere to go anywhere to get their care, so I think we've got a great, ideal location to do that.

Dr Paryani: In this population, who are generally healthy, but they usually have medical issues, most people over 65 have some medical issues, but we're going to take all takers, as long as they're willing to do the study and are able to participate willingly, and of course, it's voluntary participation, that they're willing to do that, we'll take all takers, and so we'll learn about what conditions we think we can make a difference in.

The idea here, the goal here is no matter what your condition is, can remote monitoring pick up these early signals? I'll give you an example, for instance, we have hypertension, which is very common in the over 65 group, which is elevated blood pressure. Most patients, you would think, "Well, they've monitored blood pressure," but nobody wants to do that. Really, it's not very easy to do, and even if you read it, you don't know what to do with it, so often, they just wait till the doctor's office, which may be every three, 6 months.

But what about the time in-between the doctor visits? Here, we'll be doing daily monitoring of their blood pressure, and if we even see the slightest change in the blood pressure, can we prevent any other condition from happening that's a result of high elevated blood pressure, or even lower blood pressure if they're taking medication might drop their blood pressure, and maybe they'll pass out, so we can prevent these incidents from happening.

We have a history of these patients since they've been in residence for a while at this facility for the last 12 months, and we'll monitor for the next 12 months, and see if we've actually decreased the incidence of medical events in this population, no matter what the underlying condition is.

Shyam B. Paryani, MD, MS, MHA, FACRO, FACHE, is the director of the Executive Master of Health Administration (EMHA) program and chair of the Health Administration Alumni Board in the Department of Health Administration at the Brooks College of Health, University of North Florida, Jacksonville.