Implementation of digital home monitoring and management of respiratory disease

Abstract

Purpose of review: Digital 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 over-arching societal themes of equity, trust and communication.

Recent findings: Technological 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.

Summary: Understanding and addressing the implementation challenges posed by gaps in policy, regulatory, financial, and technical infrastructure is essential to support delivery of equitable respiratory care that is acceptable to patients and professionals.

Box 1

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FIGURE 1

Vision of a connected future. On the left is the traditional referral pathway as the patient attends a clinic, may be referred to a hospital for tests or treatment and discharged home. Promising digital innovations exist (tele-consultations, on-line information, social fora, apps and reminders) are available but typically stand alone. Primary care and hospital use electronic health records (EHRs) but interoperability with different sectors or with patients is limited/nonexistent. On the right is a vision of an interconnected system in which artificial intelligence (AI)-supported self-management advice and clinical decision support is informed by a fully interoperable system. AI can use data from all these sources to tailor information provision and health promotion, monitor disease and environmental status and alert to increased risk, detect attacks and advise self-management actions, deliver home-based treatments (such as rehabilitation, hospital at home, psychological treatments) and provide social support and monitoring. Acknowledgement: the figure is created in the ICOGRAMS.

FIGURE 2

Medical device and medicinal product legislation pathways. Relevant regulation. 1. International medical device regulators forum, medical device updated includs SaMD and AIaMD, 2022, https://www.imdrf.org/meetings/web-conference-hosted-australia-0. 2. EMA. Medical Devices 2022 https://www.ema.europa.eu/en/human-regulatory/overview/medical-devices and updated for combined medicinal product and medical devices development: 2018 https://www.youtube.com/watch?v=fuewJ7gNXVI&t=403 s. 3. Reis ME, Bettencourt A, Ribeiro HM. The regulatory challenges of innovative customized combination products. Front Med 2022; 9 : 821094.