Doctors using remote patient monitoring platform to achieve care coordination

Remote Patient Monitoring and Care Coordination

Disrupting the status quo in healthcare in the United States is universally acknowledged as a necessity. The utilization of diverse technology is one example that has transformed care delivery, and telehealth is one of the most advanced and engaging tools in home healthcare to date.

It is necessary to embrace disruptive innovation. Among the telehealth applications that promise to facilitate care coordination is remote patient monitoring (RPM). RPM typically enhancing, rather than replacing, personal interactions to achieve successful care coordination.

What is Care Coordination?

Care coordination, particularly for chronic condition management and transitional care, is at the forefront of healthcare reform.

Care coordination involves deliberately organizing patient care activities and sharing information among all of the parties involved with a patient’s care in order to provide safer and more effective care. This means that the patient’s needs and preferences are known ahead of time and conveyed the right people at the right time, and that this knowledge is used to provide the patient with safe, appropriate, and effective treatment.

Care coordination’s main purpose is to meet patients’ needs and preferences while providing high-quality, high-value health care.

Agency for Healthcare Research and Quality lists down two ways of achieving coordinated care: using broad approaches that are commonly used to improve health care delivery and using specific care coordination activities.

Examples of broad care coordination approaches include:

  • Teamwork.
  • Care management.
  • Medication management.
  • Health information technology.
  • Patient-centered medical home.

Examples of specific care coordination activities include:

  • Establishing accountability and agreeing on responsibility.
  • Communicating/sharing knowledge.
  • Helping with transitions of care.
  • Assessing patient needs and goals.
  • Creating a proactive care plan.
  • Monitoring and follow-up, including responding to changes in patients’ needs.
  • Supporting patients’ self-management goals.
  • Linking to community resources.
  • Working to align resources with patient and population needs.

Why does care coordination matter?

The Institute of Medicine has identified care coordination as a key strategy for improving the effectiveness, safety, and efficiency of the American healthcare system. Patients, providers, and payers can all benefit from well-designed, focused care coordination delivered to the right people.

Although there is an apparent need for care coordination, there are barriers to overcome within the American healthcare system in order to deliver this type of care. Redesigning a health care system in order to better coordinate patients’ care is important for the following reasons:

  • Today’s healthcare systems are frequently disconnected, and processes differ between primary care and specialty care settings.
  • Patients are frequently confused about why they have been referred from primary care to a specialist, how to schedule appointments, and what to do after seeing a doctor.
  • When there is a need for primary care physician to refer a patient to a specialist, staff deal with many different processes and list information, which makes care less efficient.
  • Specialists do not always receive clear reasons for the referral or adequate information on tests that have already been done.

The Value of Telehealth in Care Coordination

Early in the COVID-19 pandemic, telemedicine emerged as a highly successful method of safely satisfying patients’ ambulatory care needs while reducing the danger of COVID transmission among patients and caregivers. Telemedicine has the potential to improve the patient experience through improved care coordination and assist health care organizations in their financial recovery, in addition to being an important vehicle for care delivery.

Patients can now use telehealth platforms like RPM to self-monitor their vitals on a regular basis and answer questions about how their symptoms are going. Furthermore, it enables physicians to receive alerts if any high-risk readings are detected, allowing them to take proactive measures to address them. Most significantly, telehealth empowers patients and encourages them to practice self-management.

Telehealth can also help to close health literacy gaps by educating patients about their disease conditions, and how to manage them. Many telehealth programs make it simple for patients to access any additional educational materials provided by their health plan or primary care provider.

Telehealth enables patients to communicate with their clinician or care coordinator via phone, video chat, or text messaging. Similarly, the clinician or care coordinator can contact the patient to check in if vital signs or symptoms are abnormal, allowing the care team to intervene and avert a potentially avoidable ED visit or hospitalization. The ability to intervene, in conjunction with resources to promote self-management and access to educational materials, has the potential to reduce excessive spending while also improving care quality.

RELATED: Chronic Care Medication Adherence: Helping Patients Take Their Medicines as Prescribed through RPM

Remote Patient Monitoring enables the provider to evaluate physiological data sent by the patient. Within the scope of remote monitoring, there are multiple billing codes. Some require automated devices with the ability to wirelessly sync and upload data points to the patient portal. There are also remote monitoring services, such as self-measured blood pressure monitoring, that do not have the same requirements. DrKumo, a leader in Next-Gen RPM, provides these innovative solutions using its easy-to-use medical devices and mobile application.

RELATED: The Internet of Medical Things (IoMT) 

Health plans that already have a care coordination team in place could use RPM devices to monitor patients’ vital signs and notify care providers of any potentially high-risk changes. Even health plans that are unable to support these operations in-house can partner with home health agencies or hospital systems that can monitor patients and keep both the care coordination team and primary care provider informed of their status.


Telehealth helps improve care coordination by enabling patients to gain a better understanding of their condition, encourages self-monitoring, expands the reach of care coordinators, and enables more actionable interventions by the patient’s care team.

To know more about how to improve care coordination through Remote Patient Monitoring, contact Drkumo®Inc.

About DrKumo® Inc. 

DrKumo is a technology leader in massively scalable, continuous, real-time Remote Patient Monitoring solution for Chronic Disease Management, Acute Care, Post-Operation, and Hospital Care at Home. 

It solves the most painful problems in healthcare with a user-friendly solution powered by its state-of-the-art, HIPAA-compliant, mobile-enabled, continuous real-time monitoring, and AI/ML engine. Then company’s Remote Patient Monitoring (RPM) technology enables patients to manage their health conditions in the comfort of their homes and supports healthcare providers with real-time intelligence for timely intervention. DrKumo revolutionizes the way people access quality health care across the world. With a culture that is innovative, collaborative, and technology-driven, DrKumo provides the most effective solutions to both patients and healthcare providers. 


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