Case Study
In March 2025, a 61-year-old female patient with a history of congestive heart failure, COPD, atrial fibrillation, chronic renal disease, and transient CNS ischemia filed a formal grievance with an integrated health system through which she had sought the majority of her medical care. Her complaint alleged that her cardiologist had neglected to monitor and respond to arrhythmias recorded by the Holter monitor which he had prescribed. She stated that the physician’s failure to adequately track results from the monitor and adjust her disease management accordingly had led to her suffering a stroke and deterioration of her cardiopulmonary health status. She threatened to pursue civil legal litigation and made a demand for compensation.
The cardiologist denied the accusation asserting that he reviews all Holter monitor reports on a bi-weekly basis, and his PAs review all critical event reports daily, reporting any concerns to the physician immediately. Furthermore, following a pre-determined time period for monitoring, the cardiologist saw the patient in his office and referred the patient for percutaneous ablation.
Advances in remote patient monitoring (RPM) technology coupled with the acceleration of telehealth adoption (coinciding with the COVID-19 pandemic) have spurred enthusiasm for the utilization of these health IT technologies across a broader patient population. Telemonitoring, originally developed for use by astronauts during space missions, provides a means for clinicians to electronically collect an assortment of physiological data between ambulatory visits and outside of acute care encounters.
Common technologies range from consumer-grade wearables such as smartwatch apps as well as medical-grade scales and blood pressure cuffs to more invasive devices. These may include pacemakers or implantable defibrillators paired with a data transmission platform to gather and communicate with medical practices and hospitals.
Further stimulated by encouragement from payer sources and the Current Procedural Terminology (CPT) Editorial Panel, a governing body established by the American Medical Association, RPM Is becoming increasingly integrated into regular patient care during periods of non-urgent medical need. Benefits include continuous monitoring of patients to provide prompt assessment of intermittent anomalies and changes in condition, improvement in patient self-care, increased patient confidence, visualization of health trends, and improved health literacy.
As with all emerging health management technologies, however, the opportunities posed by RPM are not without challenges and hazards which demand awareness and mitigation by practitioners. Clinicians participating in perception studies regarding the implementation of telemonitoring reported increased workload, higher patient anxiety, data inaccuracy, disorienting technology, and privacy concerns. Here are a few considerations associated with RPM risk management:
- Risk management authorities agree that data integrity is among the paramount concerns. With a wealth of sensitive patient information being exchanged over network connections, lack of investment in cyber security could create prime targets for attack. Administrators must prioritize data security and privacy by investing in solid security measures, such as state-of-the-art encryption, updating software across platforms, and conducting regular penetration tests. EHR integration adds another layer of scrutiny by harnessing developers’ diligence to prevent opportunities for breaches. And, of course, partner with a secure and vetted technology vendor.
- The risk of missed events or misdiagnosis is also of considerable concern. In contrast to episodic clinical assessments which provide for a snapshot, one-and done measurement or conclusion, continuous monitoring systems demand the establishment of a regular cadence for review. Clear protocols for interpretation of RPM data collected from thoroughly evaluated devices and platforms must be established. It is wise to start small and scale up, taking adequate time to assess and refine protocols. Ongoing user education is necessary to ensure maintenance of skill and integrity of related work systems.
- Finally, it behooves clinicians prescribing RPM to remain alert for and avoid over-reliance on automated clinical data collection. Algorithms that feed the user curated information may be accepted practice for social media, but generating medical alerts is a more nuanced endeavor and should be treated as such.
There is no substitute for the human element in healthcare provision. Thoughtfully scheduled, in-person checkups help to mitigate overconfidence developed through frequent observations of remotely generated data points. While RPM can provide heretofore inaccessible information about patients’ health conditions, the importance of regular interaction between patient and physician cannot be overstated.
The information provided herein does not, and is not intended to constitute legal, medical, or other professional advice; instead, this information is for general informational purposes only. The specifics of each state’s laws and the specifics of each circumstance may impact its accuracy and applicability, therefore, the information should not be relied upon for medical, legal, or financial decisions and you should consult an appropriate professional for specific advice that pertains to your situation.
Article originally published in Copic’s Copiscope 4Q25 newsletter.
