Hospital Is Not the Home: Lessons From Implementing Remote Technology to Support Acute Inpatient and Transitional Care in the Home in the United States and United Kingdom.

Abstract

The COVID-19 pandemic, patient preference, and economic opportunity are shifting acute care from the hospital to the home, supported by the transformation in remote monitoring technology. Monitoring patients with digital medical devices gives unprecedented insight into their physiology. However, this technology does not exist in a vacuum. Distinguishing pathology from physiological variability, user error, or device limitations is challenging. In a hospital, patients are monitored in a contrived environment. Monitoring at home instead captures activities of daily living alongside patients' trajectory of disease and recovery. Both settings make for "noisy" data. However, we are familiar with hospital noise, accounting for it in our practice and perceptions of normal. Home monitoring as a diagnostic intervention introduces a new set of downstream consequences, dependent on device, cadence of collection, adherence, duration, alarm thresholds, and escalation criteria. We must accept greater ambiguity and contextualize vital signs. All devices balance accuracy with acceptability, so compromises are inevitable and perfect data should not be expected. Alarms must be specific as well as sensitive, balancing clinical risk with capacity for response. By setting expectations around data from the home, we can smooth the adoption of remote monitoring and accelerate the transition of acute care.