Remote Monitoring in the Perioperative Setting: Calling for Research and Innovation Ecosystem Development

See Article, p In the past decade, exciting changes have come to medicine with improvements in health information technology and mobile connectivity. These platforms, which have formed a foundation for remote surveillance technologies, bring the importance of their study, scale, application, and sustainability in transforming the quality of health care delivery. The simultaneous emergence of wearable sensors opens new doors for continuous biometric tracking of a variety of physiological parameters, allowing for monitoring to be performed continuously both inside and outside the hospital setting. The transfer of patient-generated biometric data into an informative user interface provides a powerful tool for physicians to follow patients in more granular detail and gain actionable insights into human health. Other fields of medicine have taken advantage of these technologies to improve care quality: virtual glucose remote monitoring systems provide automated surveillance of hyperglycemic inpatients across a multisite medical center, allowing diabetes specialists to provide more immediate and higher-quality diabetic care1; in the oncology realm, emergence of remote surveillance systems into clinical practice has seen applications throughout the spectrum of care, with increased patient and family engagement.2 For anesthesiologists, remote surveillance technologies have great potential to reengineer almost every facet of perioperative care, markedly improve our understanding of human physiology in response to an acute physiological stress such as surgery or illness, and further elevate quality in perioperative care. In this issue of Anesthesia & Analgesia, Safavi et al3 published a narrative review article in which they present a compelling argument as to why anesthesiology is well positioned to lead the development of remote monitoring services for health care systems and describe opportunities and barriers involved with remote surveillance during the entire expanse of the perioperative continuum. The authors comprehensively described relevant anesthesiology use cases for remote surveillance across the perioperative health care landscape, but their article raises a couple of broader points that merit further discussion. HOW SHOULD ANESTHESIOLOGY PROFESSIONAL SOCIETIES AND ANESTHESIOLOGY DEPARTMENTS INVEST IN RESEARCH AND DEVELOPMENT OF REMOTE SURVEILLANCE TECHNOLOGIES? Innovative remote surveillance technology for its own sake is not efficacious if it contributes to wasted personnel and financial resources, and remote surveillance projects need to be designed to achieve specific health care goals. Anesthesiology departments will need to identify high-priority clinical processes or highly burdened patient populations across the perioperative continuum for which remote surveillance is appropriate to understand if these technologies actually can make a transformative impact on health care. Teams will need to utilize rigorous scientific methods to design, implement, and evaluate the use of remote surveillance technologies within a health care system, and important metrics of impact on care delivery performance, such as clinical efficacy, patient outcomes, and cost savings, will need to be studied to justify use of this technology. To be effective in studying remote surveillance technologies, anesthesiology clinician investigators will need skills that go beyond those of a traditional health services researcher. Knowledge in business and health care financing is needed to determine viable business models to offset the development cost of such a service. Strong foundations in BioDesign and user-centered design thinking methods are necessary to present vast amounts of patient-generated data in a context that allows for actionable insights for care teams. If not put in a usable context, the vast amounts of data accessible to health care providers may be difficult for care teams to interpret,4 thereby dooming adoption upfront. Knowledge of clinical informatics and health information technology will allow for remote surveillance technology to be appropriately integrated with enterprise IT infrastructure, and to ensure sustainability and adoption, strong relationships with operational partners, including health care system leaders, frontline staff, and health IT, are needed for successful execution of these projects. Training in implementation science will be critical for clinician investigators to identify the facilitators and barriers of use of remote surveillance technologies.5 Finally, given that future patients are largely digital natives, clinician investigators will also need to understand the factors that lead to adoption of consumer-wearable sensors by the future health care consumer. This requires knowledge and training in market sizing, balancing product-market fits, and user-centered design principles to raise interest for codevelopment with industry. HOW CAN LEARNING HEALTH CARE ORGANIZATIONS SUCCESSFULLY FOSTER RESEARCH AND DEVELOPMENT OF REMOTE SURVEILLANCE TECHNOLOGIES? Research on remote surveillance systems is aligned with values important to learning health systems, which utilize clinical research and care delivery to inform each other to define best practices and improve outcomes. If new models of care delivery are to be established with remote surveillance technologies, learning health care organizations should foster these local innovative efforts.6 Investigator teams will need to establish transdisciplinary and transdepartmental relationships among clinicians, administrators, IT leaders, legal counsel, privacy officers, and intellectual property. Operational colleagues need to be full partners in projects, since the implementation of remote surveillance technologies in complex health care environments will affect their current processes. Their buy-in will help to promote strategy, coordination, and visibility around a remote surveillance project that will best position it to reach its full potential to transform health care delivery. With respect to funding for these projects, federal funding for research on digital tools and remote surveillance technologies continues to lag behind that for biomedical research. New ways of obtaining funding outside the current federal-funding strategy are needed if clinician researchers are going to have an effective role in assisting health systems in delivering health care value through the use of remote surveillance technologies. With impact metrics that are distinct from federal grants, local health system innovation grants are a viable alternative for clinician investigators not typically awarded federal grants to see projects in this domain funded. In-house accelerators can provide resources and support teams to bolster the development, testing, implementation, and outcomes research of remote surveillance technologies for discrete clinical use cases. Clinical research teams may also need to closely align with industry to successfully transition remote surveillance technology research in a manner that is usable for clinicians and enables adoption among patients and stakeholders. For academic-industry codevelopment to flourish, academic ecosystems and health care organizations should foster an innovation and entrepreneurial ecosystem that brings multidisciplinary thinking of medicine, engineering, business development, and regulatory knowledge into a space of rapid prototyping and investigation. Involvement with industry will also help learning health care organizations gain early exposure to new technologies that may have potential to improve health outcomes, reduce costs, or enhance the patient experience. Understanding market sizing and product market fits are skills that are important for clinicians to have in this space because industry collaborators will devote resources toward collaborations if there is potential for scalability and revenue.5 Anesthesiology is well positioned to lead in the development of remote surveillance technologies, given the field’s history in pioneering quality and patient safety in medicine and broad footprint across the health care landscape. The trend in investigation into remote surveillance technologies has been growing across all medical fields, and it is essential to study clinical applications of these technologies in high-priority clinical processes and high-burden populations to understand if they live up to their promise of improving health care quality, standardizing processes, reducing morbidity, improving patient satisfaction, and reducing cost. Safavi et al3 have opened up an important discussion into the use of remote surveillance technologies in the future. It is up to anesthesiology clinician investigators, anesthesiology departments and professional societies, and learning health care organizations to explore whether these technologies can elevate quality in perioperative care. DISCLOSURES Name: Laleh Jalilian, MD. Contribution: This author helped draft and approve the final manuscript. Conflicts of Interest: None. Name: Maxime Cannesson, MD, PhD. Contribution: This author helped draft and approve the final manuscript. Conflicts of Interest: M. Cannesson is a consultant for Edwards Lifesciences and Masimo Corp and has funded research from Edwards Lifesciences and Masimo Corp. He is also the founder of Sironis, owns patents, and receives royalties for closed-loop hemodynamic management that have been licensed to Edwards Lifesciences. His department receives funding from the National Institutes of Health (NIH) (R01GM117622; R01 NR013012; U54HL119893; 1R01HL144692). Name: Nirav Kamdar, MD, MPP. Contribution: This author helped draft and approve the final manuscript. Conflicts of Interest: None. This manuscript was handled by: Jean-Francois Pittet, MD.