The need for access to information outside traditional patient-care settings and for enhanced communications between and among caregivers and patients has made mobile health technology one of the hottest issues in health care. On the cutting edge of mobile health is remote patient monitoring, which is reversing the dynamic of physician-patient communications — instead of the physician going to the patient to obtain information, the information now comes to the physician.
With this new technology come new challenges in risk management. Here are some examples.
Remote fetal monitoring is here; remote cardiac monitoring and remote pain assessments are on the way. As a result, in addition to the alarm going off at the nurses’ station, the alarm goes off on the physician’s cell phone.
The premise that the physician needs access to this information outside the traditional patient care setting means the patient’s record is not readily available. The risk is that there may be gaps in the documentation of the patient’s care. To address this risk, the physician must have the capability to record when the information was received; when he or she accessed the information; the response to the information, e.g., change in medications; and the outcome of the response, e.g., nurse confirms change to medications.
The technology does not yet support full integration of the remote monitoring app and the EHR or universal access to EHR via cell phone. In order to bridge the gap, the physician must be diligent in ensuring this information gets to the record. Real-time access warrants real-time documentation, so emailing a progress note to the unit would be ideal. To the extent that hospital’s policy or technology will not accommodate such documentation, the physician needs to record the data in a reliable fashion so it can be accessed to use as a reference in documenting the patient’s hospital record.
The data from remote monitoring should also be integrated with the patient’s overall clinical picture. The risk is that patient readings outside the “normal” parameters will trigger the clinical decision making tool of the EHR, which may not be appropriate given the patient’s history, but nevertheless results in an “error” message, if not followed. Ideally, the app’s monitoring parameters should be flexible so as to allow the physician to set the “normals” according to the patient’s history and present condition. If the parameters cannot be customized, the physician should have the ability to override the EHR’s clinical decision making tool and explain why those interventions were not appropriate.
Mobile health and remote monitoring offer greater access to information which can lead to better clinical decision making but which can also carry risk. To manage this risk, physicians need to do more than simply access the information; they must ensure appropriate documentation of their response to that information and integrate that data with the patient’s overall medical record.