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REMOTE PATIENT MONITORING
HEALTHCARE TRANSFORMATION
towards an advanced e-health ecosystem
Natalia Ziobrowska
WHITE
PAPER
Introduction
What is remote patient monitoring?
Why is remote patient monitoring necessary?
Comarch’s products ecosystem for remote
patient monitoring
Areas of application of remote patient
monitoring: Comarch experience
Advantages of remote patient monitoring
Summary
3
4
6
9
14
20
21
INDEX
INTRODUCTION
Changes that have a significant impact on medical care are observed
all over the world. These include aging populations, an increasing
number of chronically ill patients, and difficult access to health
services. Medical facilities, physicians and patients are facing those
challenges and their effects. The health of individuals and populations
directly affect not only the economy, but also general happiness and
life satisfaction. So, how can we maintain high-quality care while
improving access and reducing costs? In this matter, new e-health
and telemedicine technologies are needed.
Modern telemedicine systems improve medical care and optimize
costs. What’s more, they allow the provision of high-quality services
in places where these were not available previously. Their advantages
are countless, and their effectiveness has been repeatedly confirmed.
There are many products and application models. One of the
most popular and common systems is remote patient monitoring
(RPM), the topic of this white paper. Comarch meets current and
future healthcare market needs and has wide experience in patient
telemonitoring. Selected case studies present areas of use and
proposed implementation models.
Remote patient monitoring is an example of the implementation
of the P4 medicine idea, which implies predictability, prevention,
personalization, and participation. It is assumed that, by the year
2022, all four will have a strong influence on the healthcare sector.
This is linked with the growing use of new technologies, which require
changes and redefinition of roles, expanding healthcare beyond
medical facilities, increasing patient involvement their self-awareness.
It is certain that these are good and much-needed changes. Without
them, in the face of ongoing processes, efficient functioning of the
healthcare system may be difficult.
Comarch
Cloud
WHAT IS REMOTE PATIENT MONITORING?
REMOTE PATIENT MONITORING
(TELEMONITORING)
involves observing health status from outside
medical facilities. This is possible thanks to the
use of integrated measuring devices, patient
applications, and a data processing platform which
provides the information to medical staff. The
combination of these elements ensures patient
safety, whilst increasing their comfort and relieving
medical facilities. Furthermore, services are more
accessible and care costs are optimized. Patients
are under constant care of specialists who have
real-time access to up to date information about
their health. In this way, medical personnel can
monitor many more patients simultaneously,
and spend more time on communication and
education of patients, which is crucial for the
prevention and control of chronic diseases.
Due to diverse needs, there are many models and technologies used for remote
patient monitoring. Most of them have four main components:
	
Integrated devices that enable wireless
communication to send vital signs
measurements
	
Patient repositories (hub or application) that
mediate between devices and the care provider
	
Central repository of data received from sensors,
local patient repository, diagnostic applications,
etc.
	
Software that analyzes incoming data
(for example, alerts) and develops
recommendations, and shares this information
with medical staff
All elements can be adapted to the needs of
the monitored patient, specific diseases and
controlled parameters, as well as the requirements
and capabilities of a medical facility or the care
provider.
Most measuring devices currently work with
technologies adapted for remote patient
monitoring. They use different standards for
wireless data transmission, such as Bluetooth, Wi-Fi
or GSM.
Some measuring devices check specific
parameters and automatically send results,
without involving the user (i.e. biosensors or
wearable devices). Others require the patient
to enter data into a mobile application, website
or another device that acts as a connector. The
most commonly monitored parameters include
temperature, body weight, blood pressure, blood
saturation, heart rate, and blood glucose levels.
WHO CAN USE REMOTE PATIENT MONITORING?
Beneficiaries of remote monitoring services are, among others:
WHO CAN PROVIDE REMOTE PATIENT MONITORING SERVICES?
Remote patient monitoring services can be provided by, among others:
Seniors
Medical facilities
(primary care
providers and
hospitals)
Chronically ill patients
Individual medical
practices
People with
disabilities
Nursing homes
People who live in areas
with difficult access
to healthcare
Dedicated monitoring
centers
Remote patient monitoring works very well for chronically ill people, who often suffer from many different
conditions at the same time. This group of patients must be monitored regularly, and frequent visits
to medical facilities can be time-consuming and troublesome. For people with disabilities, going to a medical
facility can be a big logistical challenge, requiring the involvement of third parties. In such cases, remote
care not only saves the time of patients who do not have to go to „unnecessary” medical appointments,
but above all provides comfort, helps maintain greater independence and reduces the risk of complications.
Key features of RPM, such as remote observation and trend analysis of physiological parameters, allow
early detection of an emergency. Direct and immediate contact with medical staff allows rapid responses,
reducing the number of ER visits and shortening hospital stays. For those who find it difficult to access
medical care, remote monitoring enables regular health check-ups and medical consultations.
New technologies in medicine, including remote monitoring, support traditional medical care, intensifying
communication between patients and medical staff, and have been confirmed as delivering full diagnostic
value. They allow quick consultation with specialists, which saves time, but above all facilitate rapid, specific
decision-making so that treatment can be started or adjusted immediately. This is especially important
in the case of primary health facilities and individual medical practices that do not have extensive
specialist resources. For hospitals, remote monitoring of patients who have left the ward reduces the risk
of readmission. Nursing homes can monitor the status of people awaiting admission or requiring support
after leaving the facility. Monitoring centers are dedicated units within, for example, regional telecare
programs or which are part of a medical institution, responsible only for the care of patients covered by
remote monitoring. People supervising the safety of patients may be physicians or paramedics, who remain
in constant contact with patients and local emergency services.
THE SCALE OF REMOTE PATIENT MONITORING
As a result of growing needs, the importance and market value of remote monitoring of patients are rising
dynamically. Research and Markets experts estimate that this field will be worth $31.3 billion in 2023.
According to Goldstein Research, the value will reach $48.5 billion in 2024.
WHY IS REMOTE PATIENT MONITORING
NECESSARY?
DEMOGRAPHIC TRENDS
Societies are aging globally. According to WHO, the number of people over
60 years old will almost double between 2015 and 2050, reaching 2 billion
(including 434 million over 80 years old). Life expectancy is also rising - now
exceeding 60 years of age for the first time in history. This huge demographic
change is a challenge for healthcare and social systems all over the world.
Seniors have an important role in society and family, and longer life is associated
with many new opportunities - education, travel and discovering new passions
and hobbies. However, this all depends on a given individual’s state of health.
Elderly people more often suffer from hearing and vision problems, osteoporosis,
joint and bone pain, respiratory diseases (including COPD), diabetes, depression,
and dementia. “Geriatric syndromes” also include weakness, bone fragility,
urinary tract problems, falls and pressure sores resulting from reduced mobility
and inefficient circulation. Moreover, in this age group, the risk of multiple
diseases is increased. Unfortunately, this often results in exclusion from social life
or a significant reduction of independence.
Remote monitoring provides a system for long-term care for seniors, increasing
their safety, restoring independence and allowing greater participation in
social life. Constant observation of vital signs enables trends and changes to be
observed, so treatment can be optimized.
2015
2BILLION
2050
60+
vs
including 434 million
over 80 years old
CHRONIC DISEASES: THE LEADING CAUSE OF DEATH IN THE WORLD
„THE BIG PROBLEM” OBESITY AND RELATED DISEASES
Non-communicable diseases, including chronic diseases such as diabetes, heart failure and COPD, cause
70% of all deaths. They kill 41 million people a year, including 15 million between 30 and 69 years old. The
most dangerous are cardiovascular diseases (coronary heart disease and stroke), which have been the leading
cause of death worldwide for over 15 years. COPD is almost twice as deadly as lung, tracheal and bronchial
cancer, leading to 3 million deaths in 2016. Diabetes mortality rose by 60% in the last 16 years.
Source: Global Health Estimates 2016: Deaths by Cause, Age, Sex by Country and by Region, 2000-2016.. Geneva, World Health Organization; 2018
Ischaemic heart disease
Stroke
Chronic obstructive pulmonary disease
Lower respiratory infections
Alzheimer disease and other dementias
Trachea, bronchus, lung cancers
Diabetes mellitus
Road injury
Diarrhoeal diseases
Tuberculosis
Noncommunicable diseases
Deaths (millions)
Communicable diseases
0 2 4 6 8 10
Injuries
Obesity are carrying excess weight are classified
as chronic diseases of civilization, which can be
completely prevented. Despite this, the number
of obese people has almost tripled since 1975.
Over 39% of adults are overweight, and 13% are
obese. Currently, more people die as a result of
being overweight than from malnourishment.
Among diseases that may be a direct result of
being overweight are diabetes, hypertension,
atherosclerosis, arthrosis, sleep apnea, and
colorectal cancer.
Remote monitoring of obese patients is one
of the solutions that will help to manage this
growing problem. Medical care for overweight
patients generates many costs - it requires special
ambulances, hospital beds, and even MRI devices.
Obese patients require holistic support and regular
control. Remote monitoring provides them all
of this, whilst reducing general care costs.
Regular control of vital signs has a real impact on the results of chronic disease treatment. Remote
monitoring is a great tool to manage this group of patients, allowing quick response and improving
communication and health education. It also increases the involvement and self-awareness of patients in
their own treatment, which is equally important for the therapy results.
Top 10 global causes of death, 2016
DIFFICULT ACCESS TO MEDICAL CARE: „MEDICAL DESERTS”
IN THE USA, RURAL AREAS, DEVELOPING COUNTRIES
Difficulties in access to medical care arise almost
everywhere in the world. Reasons vary, but the
effect is the same - patients receive a late diagnosis
and treatment is delayed, which has a direct,
negative impact on the effects of therapy.
The shortage of qualified medical personnel is a
global problem. It is estimated that, in the United
States alone, by 2030 there will be a shortfall of
between 20 000 and 121 000 physicians, including
up to 49 000 internists and 72 000 specialists.
If we want to counteract a crisis that will affect the
lives of millions of people, changes should start
now. This is necessary for two reasons: first, the
demand for specialist care will continue to grow.
Second, the process of training medical staff is time
consuming (12-15 years of higher education and
specialization).
In rural areas and developing countries, the
percentage of doctors per 100 000 patients is
much lower than in cities and developed, wealthier
countries. This applies to primary care physicians
and specialists. Often, this also involves significant
distances that separate patients from hospitals
and clinics. The problem is gradually getting
worse because young doctors often emigrate
to developed, urban areas. „Medical deserts” are
deadly, especially in the case of an emergency. For
chronically ill patients, such locations mean long,
onerous journeys. RPM in rural areas with limited
access to medical care is perfect for monitoring
the population’s health status, and caring for
chronically ill or disabled patients. The system,
for example in the form of diagnostic points, will
facilitate systematic medical examinations and
consultations for everyone in the area.
Unfortunately, the dichotomy of healthcare is
very visible. Cities and developed countries offer
modern, advanced technologies, clinical trials, and
consultations with world-class specialists. Rural
areas and developing countries have problems
with access to basic medical care. Patient health
status is divided by distance and income. Remote
monitoring can help reduce these differences and
improve the availability of healthcare.
COMARCH’S PRODUCTS ECOSYSTEM FOR
REMOTE PATIENT MONITORING
Remote patient monitoring is one of Comarch’s main areas of activity in the e-health field. We have a
complete ecosystem of products that are scalable and interoperable. As a result, they can be adapted to
many needs, by modification, adding new devices, and integration with third-party systems. The system
for telemonitoring is available through Comarch Telemedicine Cloud - an open cloud platform connecting
patients and doctors through continuous, automatic data transmission. Cooperation with EHR Cloud,
Hospital Cloud, and Medical AI Cloud ensures coordinated healthcare by improving the exchange
and analysis of medical data.
EHR
Cloud
Cloud
e-Care
Medical AI
Cloud
Telemedicine
Cloud
Hospital
COMARCH E-CARE:
A TELEMEDICINE CLOUD PLATFORM
The core and basis of our telemonitoring systems is the
Comarch e-Care platform. This receives and processes
data from measuring devices, applications, and systems
for remote monitoring. Thanks to the support of
artificial intelligence (AI), even large amounts of data are
analyzed almost immediately. What is more, AI finds
correlations and irregularities, which greatly improves
diagnosis and monitoring. Medical and intervention
protocols, dedicated to all patient groups, support
and automate the care process. The Comarch
e-Care platform has a number of functionalities
ensuring comprehensive remote patient
monitoring, including remote consultations
(in the form of audio, video or chat)
and descriptions of test results.
Functionalities of the Comarch e-Care platform include, among others:
	
Integration with numerous measuring devices and telemedicine apparatus
	
Integration with HIS and EHR systems
	
Receiving and managing data
	
Data analysis with the support of learning algorithms
	
Graphic data presentation
	
Alerts when patients request help or their measurements exceed individually set thresholds
	
Rapid contact with patients (audio, video, chat)
	Patient geolocation
	Intervention procedures
	Video consultations
Comarch SMA is a set for remote monitoring, dedicated mainly for chronically ill patients. It consists of a
tablet with a special application and integrated measuring devices. The application guides the patient step
by step through all measurements, reminds them about tests and medication, and sends the results to
the Comarch e-Care platform, where information is analyzed and described by medical staff. It also saves
the measurement history, which can be accessed easily by patients and caregivers. The application is very
user-friendly and intuitive. With this support, patients can take measurements independently and correctly,
minimizing the risk of errors. The application is also available for mobile phones.
Available measuring devices: ECG event recorder, oximeter, thermometer, blood pressure meter, scale,
scale with body composition analysis, glucometer, peak flow meter, spirometer.
Most measuring devices with a Bluetooth Low Energy (BLE) wireless communication module can be
integrated with Comarch SMA. In this way, more patients can be covered by telemonitoring services. Remote
patient monitoring is also available in the BYOD (bring your own device) model, by entering measurements
manually from any given device.
THE COMARCH E-CARE PLATFORM IS A CLASS IIA MEDICAL DEVICE CERTIFIED
FOR COMPLIANCE WITH DIRECTIVE 93/42 / EEC AND ISO 13485.
Amongt the devices and systems integrated with the Comarch e-Care are:
COMARCH SMA: A HOME TELEMONITORING SET
Comarch CardioVest
a vest with innovative
textile electrodes,
enabling long-term
cardiac monitoring
Comarch homeCTG
a device for remote CTG
examination, carried out
by patients themselves
Comarch Life
Wristband
a band monitoring
patient’s pulse and
location, with an SOS
button, enabling 24-hour
telecare and contact
with the patient
Comarch PMA
a device for performing
remote Holter ECG tests
COMARCH DIAGNOSTIC POINT: RAPID MEDICAL SCREENING
AND POPULATION HEALTH MONITORING
Comarch Diagnostic Points are stations where it
is possible to conduct tests of the most important
life parameters. They can be placed, for example,
in shopping malls, insurance company premises,
offices, and hotels, and at stations and airports.
Diagnostic Points can also be located in medical
facilities and ER departments, where they
accelerate the assessment of patients’ health.
The goal is to provide rapid, easy access to high-
quality medical services, which is crucial for proper
diagnosis, prevention and treatment. Diagnostic
Points can be used for medical screening, remote
patient monitoring, health check-ups and
population tests.
Diagnostic Points can function as automated stations, where patients conduct tests independently, or can
be extended with the assistance of medical personnel. In the extended model, there is a possibility of video
consultation - remote medical consultation carried out in real time, supported by the equipment.
Diagnostic Points are also available in mobile version. The operation scheme remains the same, the only
difference is the delivery form. Measuring devices are integrated with the tablet, so the whole set can be
transported in a suitcase. In this way, Mobile Diagnostic Points can operate in places where it is difficult to
install all the traditional infrastructure, such as on aircraft or trains.
Diagnostic Points are equipped with a computer
or tablet with a dedicated application and a set
of integrated measuring devices. The application
guides the patient step by step, starting with
filling in biometric data and a medical survey.
Use of each measuring device is described and
illustrated in detail. After a session, the results and
an initial health analysis are sent to the patient’s
email address and/or to their Comarch HealthNote
account.
COMARCH HEALTHNOTE:
INTERNET HEALTH DIARY FOR PATIENTS AND PHYSICIANS
Information is a key factor in the diagnosis and
treatment process. Medical history, test results, and
data regarding current symptoms are extremely
important for all specialists. Over time, patients
accumulate more and more information. This is
often fragmentary and dispersed, stored in many
places and forms.
Comarch HealthNote
is not strictly dedicated to remote monitoring, but is a perfect complement to this form
of care. It facilitates the collection and systematization of health history and provides
reliable data and advice for patients. Charts, tables, and tags make navigation quick and
easy, even across large amounts of data. In this way, patients and physicians both save
time, and the risk of missing important information is minimized.
What’s more, Comarch HealthNote is integrated with both our telemedicine systems
and software for medical facilities (HIS and EHR systems).
A mobile application
that allows measurements
and test results to be entered,
symptoms to be registered,
health records to be scanned
and viewed, and all data to be
shared with physicians
A web application
complementing the
mobile app with additional
functionalities, enabling the use
of services via a web browser
A web application
for physicians
providing insight into
the information provided
by patients.
Comarch HealthNote is a solution created to
improve the exchange of information between
patients and doctors. It enables the collection
of comprehensive and up to date medical
documentation, which can be accessed directly via
the mobile application. Therefore, important health
information is available at any time, from anywhere.
Data are stored in a secure Comarch EHR Cloud, so
there is no risk of loss, leak or unauthorized access.
The solution includes:
AREAS OF APPLICATION OF REMOTE PATIENT
MONITORING: COMARCH EXPERIENCE
Remote monitoring can be applied for almost all patient groups, but there are areas in which it is most
useful. It is used particularly to care for high-risk patients - cardiological and pulmonary. These are among
the patient groups for whom long hospital stays are very costly, and who can suffer from complications
leading to re-admission to hospital due to lack of adequate health controls. In this case, telemonitoring
is beneficial for medical facilities, and for patients who can be closely monitored from the comfort of their
own homes.
CARDIOLOGY
Telemonitoring of patients with Comarch products
was implemented at the Centro Cardiologico
Monzino cardiological hospital in Milan. This is the
first institution in Europe dedicated exclusively
to the treatment of cardiovascular diseases.
At Centro Cardiologico Monzino, the system for
remote patient monitoring consists of:
	
Comarch e-Care platform
	
Devices for Holter ECG - Comarch PMA
	
Applications for analyzing Holter test results
On this basis, the hospital provides telemonitoring
services to diagnose patients for a period of one
or two weeks. Holter test results are analyzed by
the Comarch e-Care and CMAP platforms (with
artificial intelligence support), which significantly
improves the work of physicians. Patients at Centro
Cardiologico Monzino are also monitored via
Comarch’s system for three weeks after hospital
discharge, following surgery.
The hospital created a special unit, dedicated to
remote patient monitoring, consisting of system
operators and physicians. They analyze incoming
data and contact patients. Since May 2018, the
hospital has monitored over 100 patients in this
way.
Another cardiac care option worth mentioning
is remote hybrid rehabilitation. This involves
conducting post-infarction and post-operative
rehabilitation at home, using telemedicine
solutions, with the constant support of specialists.
Remote monitoring of MedicAir patients is
conducted using:
	
Comarch e-Care platform, collecting and
analyzing data from the apparatus
	
Comarch SMA kit - a tablet with an application
and integrated measuring devices that sends
information to the e-Care platform
PULMONOLOGY
Pulmonary patients are another group often
covered by remote monitoring. In this case, it is
necessary to check vital signs regularly, and to
supervise medication and the use of apparatus. The
diagnostic process can be time-consuming, and
treatment must be individually tailored.
The integrated measuring devices include a
peak flow meter, spirometer and pulse oximeter.
Patients perform a series of tests with the support
of the app, and the results are sent automatically to
the Comarch e-Care platform.
More than 600 patients with chronic obstructive
pulmonary disease, amyotrophic lateral sclerosis
or cystic fibrosis use remote monitoring thanks
to cooperation between the MedicAir group and
Comarch. The results show that their quality of life
and mental well-being are improving. Doctors can
detect deteriorations in patients’ health status in
The MedicAir Group is a leader in the field of
home oxygen therapy and pulmonary respirators
in Italy. In more than 30 years, it has provided
assistance to over 70 000 patients, and has been
offering telemedicine services since 2014, thanks to
cooperation with Comarch.
advance and modify the treatment, which prevents
unnecessary visits. Care costs are optimized
by reducing hospital stay durations, whilst the
comfort and satisfaction of patients who continue
treatment in their own home increases.
Comarch has been a reliable and flexible partner
for us for over four years. They managed to adapt
the Comarch e-Care platform to support us in
providing remote monitoring services for patients
affected by chronic lung and neuromuscular
system diseases. Thanks to Comarch Healthcare
solutions, the quality of life of our patients and
their mental health have improved, and the
response time in emergencies has been reduced.
Daniele Greco, Product Manager at MedicAir.
The monitored vital signs include blood saturation,
glycemia, blood pressure, and heart rate. This is
possible with the use of:
	
Comarch e-Care platform,
	Comarch SMA,
	Comarch PMA.
SENIOR CARE
Since September 2018, Comarch has been
providing remote monitoring services for patients
from nursing homes managed by T-Medic Srl, an
Italian company. The pilot project was launched at
the La Serenita center in Neroli, 50 km from Rome.
Data are sent in real time to the Comarch e-Care
Platform, operated by nursing home employees.
They analyze the information with the support of
specialists. In emergency situations during which
health or life are at risk, they can quickly intervene
and help those under their care. Reports showing
the results of monitored parameters are regularly
downloaded and forwarded to authorized patient
carers.
The long-term goal of cooperation is to extend
remote patient monitoring services to a wider
network of nursing homes in the region, through
collaboration with local GPs and specialists.
Thanks to Comarch Healthcare’s innovative offer
for telemonitoring and telecardiology solutions,
we are satisfied with the first results in La Serenità
nursing home. In particular, we are increasing the
health protection of our guests and registering a
very positive response from their relatives.
Matteo Floridi, CEO at T-Medic.
Remote monitoring of seniors can also be applied
in the case of those awaiting admission to a care
center or hospital. For this reason, the RPM system
was implemented at the Lodovico Martelli nursing
home. Patients who are on the waiting list are
monitored with the Comarch SMA kit and the
e-Care platform.
Seniors take measurements of blood saturation,
temperature and body weight every day, and
medical staff conduct bi-weekly telephone calls to
check patients’ condition.
Thanks to Comarch Healthcare technology, we
are able to provide home monitoring services
for elderly patients who are on the waiting list
to be admitted to our nursing home. On the one
hand, we remain always in contact with patients,
following their health status; on the other hand,
their families and caregivers can take care of
them more safely and autonomously.
Daniele Raspini, Director at Asp Lodovico Martelli
Comarch’s offer includes all the necessary
elements for comprehensive remote care for
pregnant women. The system we propose
consists of:
	
Comarch e-Care platforms
	
Comarch SMA kit
	
Comarch homeCTG device, enabling the patient
to perform acoustic CTG tests at home
One of the key implementations in this area has
been cooperation with the Polish Stem Cell Bank.
Over 1 200 patients received remote care provided
by the Remote Medical Care Center. Achievements
of the project include:
	
24-hour patient care carried out via the Comarch
e-Care platform
	
100 home CTG devices
	
Over 1 200 patients
	
More than 6 000 CTG tests
OBSTETRICS
Pregnant women are another group of patients
who can be monitored remotely. During
pregnancy, the most commonly monitored
parameters include body weight, glycemia,
blood pressure, baby’s heart rate, and uterine
contractions. Gestational diabetes affects between
3-9% of pregnant women. It is associated with
many complications, raising the risk of premature
delivery, pregnancy eclampsia, polyhydramnios,
etc. Hypertension is diagnosed in about 5-6%
of pregnant women. Untreated, it can result in
pre-eclampsia and pregnancy eclampsia, which
directly threaten the life of mother and child life.
This is why regular monitoring of blood pressure
of obstetric patients is extremely important.
Monitoring of body weight is necessary too
because it is closely related to the progression
of the pregnancy. Both too little and excessive
weight gain during this period have many adverse
consequences, affecting, for example, the child’s
birth weight, which can lead to complications
during childbirth and the perinatal period.
Examination of the fetal heart rate and uterine
contractions in the last trimester of pregnancy
allows for a quick response in the event of
problems or the onset or of labor.
The results from all measuring devices are sent
to the entity providing telemonitoring services
(doctor, midwife, etc.) or the Remote Medical Care
Center, and subjected to analysis. In the event
of results that give cause for concern, medical
personnel can contact the patient quickly and take
appropriate action.
Comarch has extensive experience in the field of
remote obstetric care, through cooperation with
business clients and care for individual patients.
Remote obstetric monitoring also covered patients
of the Obstetrics and Perinatology Ward of the
University Hospital in Kraków. At the Jagiellonian
University’s Collegium Medicum, the project
manager was Professor H. Huras, one of the most
recognized specialists in the field of obstetrics
and gynecology in Poland. Achievements of
cooperation include:
I’m very grateful for the opportunity to use the home CTG device. Both my husband and I could listen to our
daughter’s heartbeat, which was extremely pleasing. Test results were correct, which further assured us as
to the proper development of our child.
Patient’s opinion
	
24-hour patient care, provided by the Remote
Medical Care Center
	
20 homeCTG devices
	
Over 100 patients
	
Over 400 CTG tests
SPECIALIST CARE AND CHRONIC
DISEASES
Specialist remote monitoring, dedicated to
chronically ill patients, is a core element of the
„City of Health” projects. During implementation
in Łódź, Zabrze, Brzeg and so on, care was provided
to patients:
	With diabetes
	After strokes
	
With pulmonary disorders
	
With cardiac disorders
A system for remote monitoring of chronically
ill patients has also been launched in numerous
Italian healthcare centers. In addition to the
projects described in previous case studies, the
following examples are worth mentioning:
Remote monitoring of patients suffering from
amyotrophic lateral sclerosis (ALS), from the
Arcispedale Santa Maria Nuova hospital in Reggio
Emilia. Patients complete a medical questionnaire
and measure blood saturation and resting ECG.
Remote monitoring of patients with
neuromuscular disorders from the INRACA
specialist hospital in Monteregio. The health
status of patients is checked by measuring blood
saturation and completing a QoL (Quality of Life)
questionnaire.
Remote monitoring of patients with nutritional
disorders and gastrointestinal diseases from the
INRACA nursing home in Ancona. Remote care
is provided by nursing staff who examine the
patients’ health using the Comarch SMA kit and a
special questionnaire.
Thanks to the integration of appropriate devices,
remote monitoring can be extended to other
groups of patients, e.g. nephrological, neurological,
gastrological and those who have received organ
transplants. The system is also great for endocrine
disorders, autoimmune and mental illnesses.
.
DIAGNOSTICS
AND RAPID MEDICAL SCREENING
The purpose of Diagnostic Points is to provide
remote monitoring and diagnostics services in
public, widely available places, increasing the
number of potential users. The first Diagnostic
Point was opened in June 2019 at the Comarch
campus in Kraków. It consists of a computer with
an application that guides the user through all
tests and integrated measuring devices: event ECG
recorder, blood pressure meter, pulse oximeter,
thermometer, and scales.
Comarch employees can carry out basic
life parameter measurements without prior
registration. Before starting the session, users
complete a short medical questionnaire, providing
information about their height, diseases, physical
activity, lifestyle choices such as smoking and
alcohol consumption, etc. The test results (except
for any ECG event) are immediately visible on the
screen, letting the user know if they should consult
a doctor. In addition, as soon as the measurements
are completed, a summary and AI-supported
analysis are , sent to the given email address.
All data collected during the session are sent to
the Remote Medical Care Center and analyzed
by medical personnel. Then the patient receives
another email, this time with a detailed description
of all tests and medical recommendations.
During the first three months, over 300 employees
used the Diagnostic Point at the Comarch campus,
conducting over 570 sessions. The main advantage
of this form of care is convenience, speed, and
availability, which greatly facilitates health
monitoring and encourages users to check their
condition regularly. The whole process takes about
five minutes, and the user receives full results along
with a medical interpretation in one day.
ADVANTAGES OF REMOTE PATIENT MONITORING
Up to date and comprehensive
health information
Increased patient involvement
Better treatment results, fewer
re-admissions
Relieving medical facilities
Ability to intervene rapidly in
the event of disturbing changes
Possibility of coordinated care
Saving time for patients and
medical staff
Increased patient convenience Adjustment to caregivers’ and
patients’ needs
Reduction in care costs
Improvement of
communication between
medical staff and patients
Greater availability of services
SUMMARY
Remote patient monitoring has extensive implementation
capabilities. It can be adapted to many patient groups, and to the
needs of care providers. Changing or adding appropriate measuring
devices, or matching medical surveys, are simple modifications that
allow the most valuable data to be collected.
The use of remote monitoring has many advantages, both for medical
staff and patients. First, it relieves and „unblocks” the healthcare
system, providing more resources for people who need care in
hospitals and other medical units. For patients, it means convenience,
safety and the ability to continue treatment in the comfort of their
own home. In many cases, it significantly broadens access to medical
services. By increasing patient involvement, it raises their awareness of
their own health. This is crucial for effective prevention, diagnosis and
treatment.
Remote patient monitoring was created with current needs in mind,
and in anticipation of future requirements. It is certain that, in the face
of socio-economic changes, it will be an increasingly applied element
complementing traditional medical care. With a decreasing number
of medical staff and a rising number of patients, the role of technology
in providing adequate assistance will be crucial.
www.healthcare.comarch.com
play movie
The way we change healthcare

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Remote patient monitoring :Health care transformation

  • 1. REMOTE PATIENT MONITORING HEALTHCARE TRANSFORMATION towards an advanced e-health ecosystem Natalia Ziobrowska WHITE PAPER
  • 2. Introduction What is remote patient monitoring? Why is remote patient monitoring necessary? Comarch’s products ecosystem for remote patient monitoring Areas of application of remote patient monitoring: Comarch experience Advantages of remote patient monitoring Summary 3 4 6 9 14 20 21 INDEX
  • 3. INTRODUCTION Changes that have a significant impact on medical care are observed all over the world. These include aging populations, an increasing number of chronically ill patients, and difficult access to health services. Medical facilities, physicians and patients are facing those challenges and their effects. The health of individuals and populations directly affect not only the economy, but also general happiness and life satisfaction. So, how can we maintain high-quality care while improving access and reducing costs? In this matter, new e-health and telemedicine technologies are needed. Modern telemedicine systems improve medical care and optimize costs. What’s more, they allow the provision of high-quality services in places where these were not available previously. Their advantages are countless, and their effectiveness has been repeatedly confirmed. There are many products and application models. One of the most popular and common systems is remote patient monitoring (RPM), the topic of this white paper. Comarch meets current and future healthcare market needs and has wide experience in patient telemonitoring. Selected case studies present areas of use and proposed implementation models. Remote patient monitoring is an example of the implementation of the P4 medicine idea, which implies predictability, prevention, personalization, and participation. It is assumed that, by the year 2022, all four will have a strong influence on the healthcare sector. This is linked with the growing use of new technologies, which require changes and redefinition of roles, expanding healthcare beyond medical facilities, increasing patient involvement their self-awareness. It is certain that these are good and much-needed changes. Without them, in the face of ongoing processes, efficient functioning of the healthcare system may be difficult.
  • 4. Comarch Cloud WHAT IS REMOTE PATIENT MONITORING? REMOTE PATIENT MONITORING (TELEMONITORING) involves observing health status from outside medical facilities. This is possible thanks to the use of integrated measuring devices, patient applications, and a data processing platform which provides the information to medical staff. The combination of these elements ensures patient safety, whilst increasing their comfort and relieving medical facilities. Furthermore, services are more accessible and care costs are optimized. Patients are under constant care of specialists who have real-time access to up to date information about their health. In this way, medical personnel can monitor many more patients simultaneously, and spend more time on communication and education of patients, which is crucial for the prevention and control of chronic diseases. Due to diverse needs, there are many models and technologies used for remote patient monitoring. Most of them have four main components: Integrated devices that enable wireless communication to send vital signs measurements Patient repositories (hub or application) that mediate between devices and the care provider Central repository of data received from sensors, local patient repository, diagnostic applications, etc. Software that analyzes incoming data (for example, alerts) and develops recommendations, and shares this information with medical staff All elements can be adapted to the needs of the monitored patient, specific diseases and controlled parameters, as well as the requirements and capabilities of a medical facility or the care provider. Most measuring devices currently work with technologies adapted for remote patient monitoring. They use different standards for wireless data transmission, such as Bluetooth, Wi-Fi or GSM. Some measuring devices check specific parameters and automatically send results, without involving the user (i.e. biosensors or wearable devices). Others require the patient to enter data into a mobile application, website or another device that acts as a connector. The most commonly monitored parameters include temperature, body weight, blood pressure, blood saturation, heart rate, and blood glucose levels.
  • 5. WHO CAN USE REMOTE PATIENT MONITORING? Beneficiaries of remote monitoring services are, among others: WHO CAN PROVIDE REMOTE PATIENT MONITORING SERVICES? Remote patient monitoring services can be provided by, among others: Seniors Medical facilities (primary care providers and hospitals) Chronically ill patients Individual medical practices People with disabilities Nursing homes People who live in areas with difficult access to healthcare Dedicated monitoring centers Remote patient monitoring works very well for chronically ill people, who often suffer from many different conditions at the same time. This group of patients must be monitored regularly, and frequent visits to medical facilities can be time-consuming and troublesome. For people with disabilities, going to a medical facility can be a big logistical challenge, requiring the involvement of third parties. In such cases, remote care not only saves the time of patients who do not have to go to „unnecessary” medical appointments, but above all provides comfort, helps maintain greater independence and reduces the risk of complications. Key features of RPM, such as remote observation and trend analysis of physiological parameters, allow early detection of an emergency. Direct and immediate contact with medical staff allows rapid responses, reducing the number of ER visits and shortening hospital stays. For those who find it difficult to access medical care, remote monitoring enables regular health check-ups and medical consultations.
  • 6. New technologies in medicine, including remote monitoring, support traditional medical care, intensifying communication between patients and medical staff, and have been confirmed as delivering full diagnostic value. They allow quick consultation with specialists, which saves time, but above all facilitate rapid, specific decision-making so that treatment can be started or adjusted immediately. This is especially important in the case of primary health facilities and individual medical practices that do not have extensive specialist resources. For hospitals, remote monitoring of patients who have left the ward reduces the risk of readmission. Nursing homes can monitor the status of people awaiting admission or requiring support after leaving the facility. Monitoring centers are dedicated units within, for example, regional telecare programs or which are part of a medical institution, responsible only for the care of patients covered by remote monitoring. People supervising the safety of patients may be physicians or paramedics, who remain in constant contact with patients and local emergency services. THE SCALE OF REMOTE PATIENT MONITORING As a result of growing needs, the importance and market value of remote monitoring of patients are rising dynamically. Research and Markets experts estimate that this field will be worth $31.3 billion in 2023. According to Goldstein Research, the value will reach $48.5 billion in 2024. WHY IS REMOTE PATIENT MONITORING NECESSARY? DEMOGRAPHIC TRENDS Societies are aging globally. According to WHO, the number of people over 60 years old will almost double between 2015 and 2050, reaching 2 billion (including 434 million over 80 years old). Life expectancy is also rising - now exceeding 60 years of age for the first time in history. This huge demographic change is a challenge for healthcare and social systems all over the world. Seniors have an important role in society and family, and longer life is associated with many new opportunities - education, travel and discovering new passions and hobbies. However, this all depends on a given individual’s state of health. Elderly people more often suffer from hearing and vision problems, osteoporosis, joint and bone pain, respiratory diseases (including COPD), diabetes, depression, and dementia. “Geriatric syndromes” also include weakness, bone fragility, urinary tract problems, falls and pressure sores resulting from reduced mobility and inefficient circulation. Moreover, in this age group, the risk of multiple diseases is increased. Unfortunately, this often results in exclusion from social life or a significant reduction of independence. Remote monitoring provides a system for long-term care for seniors, increasing their safety, restoring independence and allowing greater participation in social life. Constant observation of vital signs enables trends and changes to be observed, so treatment can be optimized. 2015 2BILLION 2050 60+ vs including 434 million over 80 years old
  • 7. CHRONIC DISEASES: THE LEADING CAUSE OF DEATH IN THE WORLD „THE BIG PROBLEM” OBESITY AND RELATED DISEASES Non-communicable diseases, including chronic diseases such as diabetes, heart failure and COPD, cause 70% of all deaths. They kill 41 million people a year, including 15 million between 30 and 69 years old. The most dangerous are cardiovascular diseases (coronary heart disease and stroke), which have been the leading cause of death worldwide for over 15 years. COPD is almost twice as deadly as lung, tracheal and bronchial cancer, leading to 3 million deaths in 2016. Diabetes mortality rose by 60% in the last 16 years. Source: Global Health Estimates 2016: Deaths by Cause, Age, Sex by Country and by Region, 2000-2016.. Geneva, World Health Organization; 2018 Ischaemic heart disease Stroke Chronic obstructive pulmonary disease Lower respiratory infections Alzheimer disease and other dementias Trachea, bronchus, lung cancers Diabetes mellitus Road injury Diarrhoeal diseases Tuberculosis Noncommunicable diseases Deaths (millions) Communicable diseases 0 2 4 6 8 10 Injuries Obesity are carrying excess weight are classified as chronic diseases of civilization, which can be completely prevented. Despite this, the number of obese people has almost tripled since 1975. Over 39% of adults are overweight, and 13% are obese. Currently, more people die as a result of being overweight than from malnourishment. Among diseases that may be a direct result of being overweight are diabetes, hypertension, atherosclerosis, arthrosis, sleep apnea, and colorectal cancer. Remote monitoring of obese patients is one of the solutions that will help to manage this growing problem. Medical care for overweight patients generates many costs - it requires special ambulances, hospital beds, and even MRI devices. Obese patients require holistic support and regular control. Remote monitoring provides them all of this, whilst reducing general care costs. Regular control of vital signs has a real impact on the results of chronic disease treatment. Remote monitoring is a great tool to manage this group of patients, allowing quick response and improving communication and health education. It also increases the involvement and self-awareness of patients in their own treatment, which is equally important for the therapy results. Top 10 global causes of death, 2016
  • 8. DIFFICULT ACCESS TO MEDICAL CARE: „MEDICAL DESERTS” IN THE USA, RURAL AREAS, DEVELOPING COUNTRIES Difficulties in access to medical care arise almost everywhere in the world. Reasons vary, but the effect is the same - patients receive a late diagnosis and treatment is delayed, which has a direct, negative impact on the effects of therapy. The shortage of qualified medical personnel is a global problem. It is estimated that, in the United States alone, by 2030 there will be a shortfall of between 20 000 and 121 000 physicians, including up to 49 000 internists and 72 000 specialists. If we want to counteract a crisis that will affect the lives of millions of people, changes should start now. This is necessary for two reasons: first, the demand for specialist care will continue to grow. Second, the process of training medical staff is time consuming (12-15 years of higher education and specialization). In rural areas and developing countries, the percentage of doctors per 100 000 patients is much lower than in cities and developed, wealthier countries. This applies to primary care physicians and specialists. Often, this also involves significant distances that separate patients from hospitals and clinics. The problem is gradually getting worse because young doctors often emigrate to developed, urban areas. „Medical deserts” are deadly, especially in the case of an emergency. For chronically ill patients, such locations mean long, onerous journeys. RPM in rural areas with limited access to medical care is perfect for monitoring the population’s health status, and caring for chronically ill or disabled patients. The system, for example in the form of diagnostic points, will facilitate systematic medical examinations and consultations for everyone in the area. Unfortunately, the dichotomy of healthcare is very visible. Cities and developed countries offer modern, advanced technologies, clinical trials, and consultations with world-class specialists. Rural areas and developing countries have problems with access to basic medical care. Patient health status is divided by distance and income. Remote monitoring can help reduce these differences and improve the availability of healthcare.
  • 9. COMARCH’S PRODUCTS ECOSYSTEM FOR REMOTE PATIENT MONITORING Remote patient monitoring is one of Comarch’s main areas of activity in the e-health field. We have a complete ecosystem of products that are scalable and interoperable. As a result, they can be adapted to many needs, by modification, adding new devices, and integration with third-party systems. The system for telemonitoring is available through Comarch Telemedicine Cloud - an open cloud platform connecting patients and doctors through continuous, automatic data transmission. Cooperation with EHR Cloud, Hospital Cloud, and Medical AI Cloud ensures coordinated healthcare by improving the exchange and analysis of medical data. EHR Cloud Cloud e-Care Medical AI Cloud Telemedicine Cloud Hospital
  • 10. COMARCH E-CARE: A TELEMEDICINE CLOUD PLATFORM The core and basis of our telemonitoring systems is the Comarch e-Care platform. This receives and processes data from measuring devices, applications, and systems for remote monitoring. Thanks to the support of artificial intelligence (AI), even large amounts of data are analyzed almost immediately. What is more, AI finds correlations and irregularities, which greatly improves diagnosis and monitoring. Medical and intervention protocols, dedicated to all patient groups, support and automate the care process. The Comarch e-Care platform has a number of functionalities ensuring comprehensive remote patient monitoring, including remote consultations (in the form of audio, video or chat) and descriptions of test results. Functionalities of the Comarch e-Care platform include, among others: Integration with numerous measuring devices and telemedicine apparatus Integration with HIS and EHR systems Receiving and managing data Data analysis with the support of learning algorithms Graphic data presentation Alerts when patients request help or their measurements exceed individually set thresholds Rapid contact with patients (audio, video, chat) Patient geolocation Intervention procedures Video consultations
  • 11. Comarch SMA is a set for remote monitoring, dedicated mainly for chronically ill patients. It consists of a tablet with a special application and integrated measuring devices. The application guides the patient step by step through all measurements, reminds them about tests and medication, and sends the results to the Comarch e-Care platform, where information is analyzed and described by medical staff. It also saves the measurement history, which can be accessed easily by patients and caregivers. The application is very user-friendly and intuitive. With this support, patients can take measurements independently and correctly, minimizing the risk of errors. The application is also available for mobile phones. Available measuring devices: ECG event recorder, oximeter, thermometer, blood pressure meter, scale, scale with body composition analysis, glucometer, peak flow meter, spirometer. Most measuring devices with a Bluetooth Low Energy (BLE) wireless communication module can be integrated with Comarch SMA. In this way, more patients can be covered by telemonitoring services. Remote patient monitoring is also available in the BYOD (bring your own device) model, by entering measurements manually from any given device. THE COMARCH E-CARE PLATFORM IS A CLASS IIA MEDICAL DEVICE CERTIFIED FOR COMPLIANCE WITH DIRECTIVE 93/42 / EEC AND ISO 13485. Amongt the devices and systems integrated with the Comarch e-Care are: COMARCH SMA: A HOME TELEMONITORING SET Comarch CardioVest a vest with innovative textile electrodes, enabling long-term cardiac monitoring Comarch homeCTG a device for remote CTG examination, carried out by patients themselves Comarch Life Wristband a band monitoring patient’s pulse and location, with an SOS button, enabling 24-hour telecare and contact with the patient Comarch PMA a device for performing remote Holter ECG tests
  • 12. COMARCH DIAGNOSTIC POINT: RAPID MEDICAL SCREENING AND POPULATION HEALTH MONITORING Comarch Diagnostic Points are stations where it is possible to conduct tests of the most important life parameters. They can be placed, for example, in shopping malls, insurance company premises, offices, and hotels, and at stations and airports. Diagnostic Points can also be located in medical facilities and ER departments, where they accelerate the assessment of patients’ health. The goal is to provide rapid, easy access to high- quality medical services, which is crucial for proper diagnosis, prevention and treatment. Diagnostic Points can be used for medical screening, remote patient monitoring, health check-ups and population tests. Diagnostic Points can function as automated stations, where patients conduct tests independently, or can be extended with the assistance of medical personnel. In the extended model, there is a possibility of video consultation - remote medical consultation carried out in real time, supported by the equipment. Diagnostic Points are also available in mobile version. The operation scheme remains the same, the only difference is the delivery form. Measuring devices are integrated with the tablet, so the whole set can be transported in a suitcase. In this way, Mobile Diagnostic Points can operate in places where it is difficult to install all the traditional infrastructure, such as on aircraft or trains. Diagnostic Points are equipped with a computer or tablet with a dedicated application and a set of integrated measuring devices. The application guides the patient step by step, starting with filling in biometric data and a medical survey. Use of each measuring device is described and illustrated in detail. After a session, the results and an initial health analysis are sent to the patient’s email address and/or to their Comarch HealthNote account.
  • 13. COMARCH HEALTHNOTE: INTERNET HEALTH DIARY FOR PATIENTS AND PHYSICIANS Information is a key factor in the diagnosis and treatment process. Medical history, test results, and data regarding current symptoms are extremely important for all specialists. Over time, patients accumulate more and more information. This is often fragmentary and dispersed, stored in many places and forms. Comarch HealthNote is not strictly dedicated to remote monitoring, but is a perfect complement to this form of care. It facilitates the collection and systematization of health history and provides reliable data and advice for patients. Charts, tables, and tags make navigation quick and easy, even across large amounts of data. In this way, patients and physicians both save time, and the risk of missing important information is minimized. What’s more, Comarch HealthNote is integrated with both our telemedicine systems and software for medical facilities (HIS and EHR systems). A mobile application that allows measurements and test results to be entered, symptoms to be registered, health records to be scanned and viewed, and all data to be shared with physicians A web application complementing the mobile app with additional functionalities, enabling the use of services via a web browser A web application for physicians providing insight into the information provided by patients. Comarch HealthNote is a solution created to improve the exchange of information between patients and doctors. It enables the collection of comprehensive and up to date medical documentation, which can be accessed directly via the mobile application. Therefore, important health information is available at any time, from anywhere. Data are stored in a secure Comarch EHR Cloud, so there is no risk of loss, leak or unauthorized access. The solution includes:
  • 14. AREAS OF APPLICATION OF REMOTE PATIENT MONITORING: COMARCH EXPERIENCE Remote monitoring can be applied for almost all patient groups, but there are areas in which it is most useful. It is used particularly to care for high-risk patients - cardiological and pulmonary. These are among the patient groups for whom long hospital stays are very costly, and who can suffer from complications leading to re-admission to hospital due to lack of adequate health controls. In this case, telemonitoring is beneficial for medical facilities, and for patients who can be closely monitored from the comfort of their own homes. CARDIOLOGY Telemonitoring of patients with Comarch products was implemented at the Centro Cardiologico Monzino cardiological hospital in Milan. This is the first institution in Europe dedicated exclusively to the treatment of cardiovascular diseases. At Centro Cardiologico Monzino, the system for remote patient monitoring consists of: Comarch e-Care platform Devices for Holter ECG - Comarch PMA Applications for analyzing Holter test results On this basis, the hospital provides telemonitoring services to diagnose patients for a period of one or two weeks. Holter test results are analyzed by the Comarch e-Care and CMAP platforms (with artificial intelligence support), which significantly improves the work of physicians. Patients at Centro Cardiologico Monzino are also monitored via Comarch’s system for three weeks after hospital discharge, following surgery. The hospital created a special unit, dedicated to remote patient monitoring, consisting of system operators and physicians. They analyze incoming data and contact patients. Since May 2018, the hospital has monitored over 100 patients in this way. Another cardiac care option worth mentioning is remote hybrid rehabilitation. This involves conducting post-infarction and post-operative rehabilitation at home, using telemedicine solutions, with the constant support of specialists.
  • 15. Remote monitoring of MedicAir patients is conducted using: Comarch e-Care platform, collecting and analyzing data from the apparatus Comarch SMA kit - a tablet with an application and integrated measuring devices that sends information to the e-Care platform PULMONOLOGY Pulmonary patients are another group often covered by remote monitoring. In this case, it is necessary to check vital signs regularly, and to supervise medication and the use of apparatus. The diagnostic process can be time-consuming, and treatment must be individually tailored. The integrated measuring devices include a peak flow meter, spirometer and pulse oximeter. Patients perform a series of tests with the support of the app, and the results are sent automatically to the Comarch e-Care platform. More than 600 patients with chronic obstructive pulmonary disease, amyotrophic lateral sclerosis or cystic fibrosis use remote monitoring thanks to cooperation between the MedicAir group and Comarch. The results show that their quality of life and mental well-being are improving. Doctors can detect deteriorations in patients’ health status in The MedicAir Group is a leader in the field of home oxygen therapy and pulmonary respirators in Italy. In more than 30 years, it has provided assistance to over 70 000 patients, and has been offering telemedicine services since 2014, thanks to cooperation with Comarch. advance and modify the treatment, which prevents unnecessary visits. Care costs are optimized by reducing hospital stay durations, whilst the comfort and satisfaction of patients who continue treatment in their own home increases. Comarch has been a reliable and flexible partner for us for over four years. They managed to adapt the Comarch e-Care platform to support us in providing remote monitoring services for patients affected by chronic lung and neuromuscular system diseases. Thanks to Comarch Healthcare solutions, the quality of life of our patients and their mental health have improved, and the response time in emergencies has been reduced. Daniele Greco, Product Manager at MedicAir.
  • 16. The monitored vital signs include blood saturation, glycemia, blood pressure, and heart rate. This is possible with the use of: Comarch e-Care platform, Comarch SMA, Comarch PMA. SENIOR CARE Since September 2018, Comarch has been providing remote monitoring services for patients from nursing homes managed by T-Medic Srl, an Italian company. The pilot project was launched at the La Serenita center in Neroli, 50 km from Rome. Data are sent in real time to the Comarch e-Care Platform, operated by nursing home employees. They analyze the information with the support of specialists. In emergency situations during which health or life are at risk, they can quickly intervene and help those under their care. Reports showing the results of monitored parameters are regularly downloaded and forwarded to authorized patient carers. The long-term goal of cooperation is to extend remote patient monitoring services to a wider network of nursing homes in the region, through collaboration with local GPs and specialists. Thanks to Comarch Healthcare’s innovative offer for telemonitoring and telecardiology solutions, we are satisfied with the first results in La Serenità nursing home. In particular, we are increasing the health protection of our guests and registering a very positive response from their relatives. Matteo Floridi, CEO at T-Medic. Remote monitoring of seniors can also be applied in the case of those awaiting admission to a care center or hospital. For this reason, the RPM system was implemented at the Lodovico Martelli nursing home. Patients who are on the waiting list are monitored with the Comarch SMA kit and the e-Care platform. Seniors take measurements of blood saturation, temperature and body weight every day, and medical staff conduct bi-weekly telephone calls to check patients’ condition. Thanks to Comarch Healthcare technology, we are able to provide home monitoring services for elderly patients who are on the waiting list to be admitted to our nursing home. On the one hand, we remain always in contact with patients, following their health status; on the other hand, their families and caregivers can take care of them more safely and autonomously. Daniele Raspini, Director at Asp Lodovico Martelli
  • 17. Comarch’s offer includes all the necessary elements for comprehensive remote care for pregnant women. The system we propose consists of: Comarch e-Care platforms Comarch SMA kit Comarch homeCTG device, enabling the patient to perform acoustic CTG tests at home One of the key implementations in this area has been cooperation with the Polish Stem Cell Bank. Over 1 200 patients received remote care provided by the Remote Medical Care Center. Achievements of the project include: 24-hour patient care carried out via the Comarch e-Care platform 100 home CTG devices Over 1 200 patients More than 6 000 CTG tests OBSTETRICS Pregnant women are another group of patients who can be monitored remotely. During pregnancy, the most commonly monitored parameters include body weight, glycemia, blood pressure, baby’s heart rate, and uterine contractions. Gestational diabetes affects between 3-9% of pregnant women. It is associated with many complications, raising the risk of premature delivery, pregnancy eclampsia, polyhydramnios, etc. Hypertension is diagnosed in about 5-6% of pregnant women. Untreated, it can result in pre-eclampsia and pregnancy eclampsia, which directly threaten the life of mother and child life. This is why regular monitoring of blood pressure of obstetric patients is extremely important. Monitoring of body weight is necessary too because it is closely related to the progression of the pregnancy. Both too little and excessive weight gain during this period have many adverse consequences, affecting, for example, the child’s birth weight, which can lead to complications during childbirth and the perinatal period. Examination of the fetal heart rate and uterine contractions in the last trimester of pregnancy allows for a quick response in the event of problems or the onset or of labor. The results from all measuring devices are sent to the entity providing telemonitoring services (doctor, midwife, etc.) or the Remote Medical Care Center, and subjected to analysis. In the event of results that give cause for concern, medical personnel can contact the patient quickly and take appropriate action. Comarch has extensive experience in the field of remote obstetric care, through cooperation with business clients and care for individual patients.
  • 18. Remote obstetric monitoring also covered patients of the Obstetrics and Perinatology Ward of the University Hospital in Kraków. At the Jagiellonian University’s Collegium Medicum, the project manager was Professor H. Huras, one of the most recognized specialists in the field of obstetrics and gynecology in Poland. Achievements of cooperation include: I’m very grateful for the opportunity to use the home CTG device. Both my husband and I could listen to our daughter’s heartbeat, which was extremely pleasing. Test results were correct, which further assured us as to the proper development of our child. Patient’s opinion 24-hour patient care, provided by the Remote Medical Care Center 20 homeCTG devices Over 100 patients Over 400 CTG tests SPECIALIST CARE AND CHRONIC DISEASES Specialist remote monitoring, dedicated to chronically ill patients, is a core element of the „City of Health” projects. During implementation in Łódź, Zabrze, Brzeg and so on, care was provided to patients: With diabetes After strokes With pulmonary disorders With cardiac disorders A system for remote monitoring of chronically ill patients has also been launched in numerous Italian healthcare centers. In addition to the projects described in previous case studies, the following examples are worth mentioning: Remote monitoring of patients suffering from amyotrophic lateral sclerosis (ALS), from the Arcispedale Santa Maria Nuova hospital in Reggio Emilia. Patients complete a medical questionnaire and measure blood saturation and resting ECG. Remote monitoring of patients with neuromuscular disorders from the INRACA specialist hospital in Monteregio. The health status of patients is checked by measuring blood saturation and completing a QoL (Quality of Life) questionnaire. Remote monitoring of patients with nutritional disorders and gastrointestinal diseases from the INRACA nursing home in Ancona. Remote care is provided by nursing staff who examine the patients’ health using the Comarch SMA kit and a special questionnaire. Thanks to the integration of appropriate devices, remote monitoring can be extended to other groups of patients, e.g. nephrological, neurological, gastrological and those who have received organ transplants. The system is also great for endocrine disorders, autoimmune and mental illnesses. .
  • 19. DIAGNOSTICS AND RAPID MEDICAL SCREENING The purpose of Diagnostic Points is to provide remote monitoring and diagnostics services in public, widely available places, increasing the number of potential users. The first Diagnostic Point was opened in June 2019 at the Comarch campus in Kraków. It consists of a computer with an application that guides the user through all tests and integrated measuring devices: event ECG recorder, blood pressure meter, pulse oximeter, thermometer, and scales. Comarch employees can carry out basic life parameter measurements without prior registration. Before starting the session, users complete a short medical questionnaire, providing information about their height, diseases, physical activity, lifestyle choices such as smoking and alcohol consumption, etc. The test results (except for any ECG event) are immediately visible on the screen, letting the user know if they should consult a doctor. In addition, as soon as the measurements are completed, a summary and AI-supported analysis are , sent to the given email address. All data collected during the session are sent to the Remote Medical Care Center and analyzed by medical personnel. Then the patient receives another email, this time with a detailed description of all tests and medical recommendations. During the first three months, over 300 employees used the Diagnostic Point at the Comarch campus, conducting over 570 sessions. The main advantage of this form of care is convenience, speed, and availability, which greatly facilitates health monitoring and encourages users to check their condition regularly. The whole process takes about five minutes, and the user receives full results along with a medical interpretation in one day.
  • 20. ADVANTAGES OF REMOTE PATIENT MONITORING Up to date and comprehensive health information Increased patient involvement Better treatment results, fewer re-admissions Relieving medical facilities Ability to intervene rapidly in the event of disturbing changes Possibility of coordinated care Saving time for patients and medical staff Increased patient convenience Adjustment to caregivers’ and patients’ needs Reduction in care costs Improvement of communication between medical staff and patients Greater availability of services
  • 21. SUMMARY Remote patient monitoring has extensive implementation capabilities. It can be adapted to many patient groups, and to the needs of care providers. Changing or adding appropriate measuring devices, or matching medical surveys, are simple modifications that allow the most valuable data to be collected. The use of remote monitoring has many advantages, both for medical staff and patients. First, it relieves and „unblocks” the healthcare system, providing more resources for people who need care in hospitals and other medical units. For patients, it means convenience, safety and the ability to continue treatment in the comfort of their own home. In many cases, it significantly broadens access to medical services. By increasing patient involvement, it raises their awareness of their own health. This is crucial for effective prevention, diagnosis and treatment. Remote patient monitoring was created with current needs in mind, and in anticipation of future requirements. It is certain that, in the face of socio-economic changes, it will be an increasingly applied element complementing traditional medical care. With a decreasing number of medical staff and a rising number of patients, the role of technology in providing adequate assistance will be crucial.