Implementation of digital home monitoring and management of respiratory disease

Abstract

Purpose of reviewDigital respiratory monitoring interventions (e.g. smart inhalers and digital spirometers) can improve clinical outcomes and/or organizational efficiency, and the focus is shifting to sustainable implementation as an approach to delivering respiratory care. This review considers key aspects of the technology infrastructure, discusses the regulatory, financial and policy context that influence implementation, and highlights the overarching societal themes of equity, trust and communication. Recent findingsTechnological requirements include developing interoperable and connected systems; establishing stable, wide internet coverage; addressing data accuracy and monitoring adherence; realising the potential of artificial intelligence; and avoiding clinician data overload. Policy challenges include concerns about quality assurance and increasingly complex regulatory systems. Financial barriers include lack of clarity over cost-effectiveness, budget impact and reimbursement. Societal concerns focus on the potential to increase inequities because of poor e-health literacy, deprivation or lack of available infrastructure, the need to understand the implications for patient/professional interactions of shifting care to remote delivery and ensuring confidentiality of personal data.

Digital inhalers for asthma management

“…Physicians expressed concerns surrounding the Health Insurance Portability and Accountability Act (HIPAA) that protects personal medical information [28]. Legislation will be necessary to ensure patient confidence in digital healthcare interventions [29].…”

REMOTE-ILD study: Description of the protocol for a multicentre, 12-month randomised controlled trial to assess the clinical and cost-effectiveness of remote monitoring of spirometry and pulse oximetry in patients with interstitial lung disease

“… 26 Other concerns raised about integrating new digital health systems include both data overload, but also that artificial intelligence may not be able to detect subtler nuances, such as missing data may represent periods of either good health or deterioration. 28 …”

The lung way home: ready for home monitoring in lung diseases?

“…This issue of Current Opinion in Pulmonary Medicine provides a state-of-the-art on home monitoring in chronic obstructive pulmonary disease (COPD), asthma, cystic fibrosis (CF), interstitial lung disease (ILD), and COVID-19, as well as novel insights into telerehabilitation, digital outcome measures, and implementation barriers [5–12]. Although home monitoring seems to be feasible across pulmonary medicine, data on clinical efficacy and cost-effectiveness are not unequivocally positive.…”

“…However, long-term sustainable implementation beyond the COVID-19 pandemic is still hampered by various factors, including policy challenges, financial barriers, technological infrastructure, and societal concerns. Pinnock and colleagues [10] comprehensively review all these key aspects for successful implementation of home monitoring in lung diseases. One of the important societal concerns is poor digital literacy, which may lead to increasing health inequity in the era of digital healthcare.…”

“…The IoMT refers to the technical infrastructure that connects software applications and medical devices to healthcare information technology systems, facilitating integration and central storage of patient data. Current digital solutions are often not connected and lack interoperability, which is an important prerequisite for artificial intelligence driven support systems [8,10]. Drummond et al [6] argue for more research into the application of digital twin systems in asthma.…”