ATA trend #1: Is a sustainable RPM infrastructure fact or fiction?

Guest columnist Dr Vikrum (Sunny) Malhotra attended ATA 2015 last week. This is the first of three articles on his observations on trends and companies to watch.

The advancement of remote patient monitoring is a visible trend from the American Telemedicine Association’s 2015 meeting, with care moving from the doctor’s office and being shifted to the patient’s home. A more diverse range of data is being collected for patients to facilitate more informed decision making at the patient visit and after the patient is away from the practice. As information is being collected and monitored on a more comprehensive basis, we have seen creative modalities to view a broad array of data points that would typically have been collected in a doctor’s office with the hopes of early diagnosis and preventive care, versus reactive care.

Patient autonomy has now come to the forefront and network infrastructure is being built to support that shift. Wearables, implantables and home based lab/ urine diagnostic kits are becoming smaller, cheaper, less invasive, wireless and cloud-based so that patients can be monitored without interfering in day to day living. In speaking with Robert Kaul, founder and president of Cloud DX (a finalist in the Qualcomm XPRIZE competition), he summed up the current state: “It is an exciting time in telemedicine to be collecting data to use in our homes and present actionable information through integration from our cloud based software to the physicians.”

As data is being collected, I have seen a move towards wireless solutions and the data collection being shifted to the cloud, to make integration with physician practices seamless. Integration with multiple large vendors has been a barrier to ubiquity of use in the care collaboration of patients. Remote patient monitoring has attempted for years to establish that early pre-clinical visit diagnoses will result in reduced admission rates, but has shown varying success rates in different disease pathologies.

Economic analyses from clinician practices and state/federal governments see utilization of health resources differently. Jonathon Linkous, President of ATA, said that “The American Medical Association and CPT coding committee are moving to look at coding and remote monitoring before paying as a first step in this complicated payment system. We are going to be moving to a new wave of providing healthcare.” On the Federal level, the Chronic Care Management program has recently introduced CPT (current procedural terminology) code 99490 and 99091 for collection of remote asynchronous patient biometric data to assist in telehealth care of Medicare patients. Patients must have >2 chronic CMS conditions which will last at least 12 months and >20 minutes of review and interpretation of data for clinical decision making purposes.

At the end of the ATA conference, it became clear that most companies visited are still trying to grasp how to incorporate the unstackable CPT codes 99490 and 99091 to create sustainable remote patient monitoring infrastructures.

Vikrum (Sunny) Malhotra, MD is a US trained cardiologist who was named one of the top “Doctors on Twitter” to follow. He was named Best in Healthcare Ontario – Notable Young Professional 2014. He is an entrepreneur and health tech investor. He is the founder of, a telemedicine practice in Ontario, Canada. @DrSunnyMalhotra

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