What comprehensive questions should be asked to plan remote patient monitoring for a patient, including age, gender, primary language, diagnoses and disease severity, target symptoms or events, medications and recent changes, recent hospitalizations or exacerbations, comorbidities, vital signs or biometric data to collect, measurement frequency and timing, device type and validation, internet and technology access, patient comfort with technology, data transmission and alert thresholds, alert recipients and response protocol, patient goals and preferences, privacy concerns, insurance coverage, medication adherence assessment, device contraindications, and required education and training?

Comprehensive Questions for Remote Patient Monitoring Planning

When establishing remote patient monitoring (RPM), you must systematically assess patient-specific factors, technological capabilities, clinical parameters, and safety protocols to ensure effective implementation and optimal outcomes. 1

Patient Demographics and Clinical Profile

Basic Information

• Age and developmental stage (particularly important for pediatric patients where growth and pubertal development affect monitoring needs) 1
• Primary language and communication preferences (critical for ensuring patient understanding and engagement) 1
• Educational level (impacts ability to use technology and understand educational materials) 2

Disease-Specific Assessment

• Primary diagnosis with severity staging (determines which parameters require monitoring) 1, 3
• Recent hospitalizations or emergency department visits (within past 6 months, including causes and frequency) 1
• History of disease exacerbations (timing, triggers, and severity) 1
• Current disease control status (stable vs. decompensating) 4

Comorbidity Evaluation

• All active comorbidities (particularly cardiovascular disease, diabetes, obesity, sleep apnea, liver disease) 1
• Autoimmune disorders (especially relevant for diabetes patients) 1
• Mental health conditions (depression, anxiety, diabetes distress, eating disorders) 1
• Cognitive function status (impacts ability to use devices independently) 1

Medication and Treatment History

Current Medications

• Complete medication list with dosages and frequencies 1
• Recent medication changes (within past 3 months) 1
• Medication adherence patterns (including any history of rationing medications or supplies) 1
• Medication side effects or intolerances 1

Treatment-Specific Considerations

• For diabetes: insulin pump settings, connected pen data, continuous glucose monitoring use 1
• For cardiac patients: pacemaker/ICD type, programming, and current remote monitoring status 1
• QT-prolonging medications (particularly relevant during COVID-19 era with hydroxychloroquine, azithromycin) 1

Target Monitoring Parameters

Vital Signs and Biometric Data

• Which specific parameters to monitor (pulse rate, blood pressure, temperature, respiratory rate, oxygen saturation, weight) 1
• Target ranges and alert thresholds for each parameter 1
• Measurement frequency (continuous vs. intermittent; daily vs. multiple times daily) 1, 4
• Optimal timing of measurements (fasting, pre/post-meal, before bed) 1

Disease-Specific Metrics

• For diabetes: glucose patterns, A1C trends, hypoglycemia frequency and awareness 1
• For cardiac patients: arrhythmia detection, pacemaker threshold checks, battery status 1, 5
• For heart failure: daily weights, edema assessment, dyspnea scores 4

Technology Assessment and Access

Device Selection

• Type of monitoring device required (smartphone-based, wearable, patch monitor, implantable device interrogation) 1
• Device validation status (FDA-cleared vs. consumer-grade) 1
• Factory calibration vs. manual calibration requirements 6
• Sensor replacement frequency (e.g., Dexcom G6 requires replacement every 10 days) 6

Infrastructure Evaluation

• Internet connectivity at home (broadband availability and reliability) 1
• Smartphone or computer ownership and operating system 1
• Cellular data plan adequacy (for devices requiring data transmission) 1
• Physical barriers (vision impairment, hearing loss, manual dexterity limitations) 1

Patient Technology Competency

• Current comfort level with technology (smartphones, apps, computers) 1, 2
• Previous experience with health apps or patient portals 1
• Ability to troubleshoot basic technical issues independently 7, 2
• Availability of caregiver support for device management 1

Data Management and Alert Protocols

Data Transmission

• Automatic vs. manual data upload preference (patients prefer automatic transmission) 8
• Real-time vs. batch transmission 1
• Electronic health record integration requirements 1
• Data storage and backup protocols 1

Alert Configuration

• Specific threshold values triggering alerts (high/low glucose, abnormal heart rate, blood pressure limits) 1
• Alert recipients (patient, primary care physician, specialist, remote monitoring center) 1
• Response protocol for each alert type (immediate call, same-day appointment, emergency services) 1, 3
• Escalation pathway for non-response 3

Clinical Workflow Integration

Monitoring Schedule

• For pacemakers: twice in first 6 months, then every 12 months (single-chamber) or every 6 months (dual-chamber) 1, 5
• For continuous glucose monitors: review patterns rather than individual values in dialysis patients 6
• Frequency of clinician review of transmitted data 1, 4
• Scheduled virtual visit intervals 1

Communication Plan

• Primary contact method (video telehealth, telephone, secure messaging) 1
• Availability of technical support (24/7 vs. business hours) 2, 8
• Language interpretation services if needed 1
• Process for urgent vs. routine communications 1

Patient Goals and Preferences

Personal Objectives

• Patient's specific health goals (symptom reduction, hospitalization avoidance, independence maintenance) 1, 2
• Preferred level of monitoring intensity (continuous vs. intermittent) 4
• Comfort with remote vs. in-person care balance 2
• Desire for family member involvement in monitoring 1

Privacy and Security Concerns

• Understanding of data sharing and privacy protections 1
• Consent for data transmission to multiple providers 1
• Concerns about data security or breaches 1
• For adolescents: need for confidential communication space 1

Social Determinants and Support Systems

Environmental Factors

• Housing stability and home environment safety 1
• Food security status (impacts diabetes management, medication adherence) 1
• Transportation access for in-person visits when needed 1
• Community safety concerns 1

Support Network

• Identification of surrogate decision-maker 1
• Advance care planning status 1
• Daily routine and work/school schedule (impacts measurement timing) 1
• Caregiver availability for device assistance 1

Financial and Coverage Assessment

Insurance Verification

• Insurance coverage for RPM services (Medicare, Medicaid, commercial) 1
• Prior authorization requirements 1
• Patient cost-sharing responsibilities 8
• Coverage for specific devices and supplies 1

Financial Barriers

• Ability to afford device, supplies, and data plan 1
• History of medication or supply rationing due to cost 1
• Need for financial assistance programs 1

Safety and Contraindications

Device-Specific Considerations

• Contraindications to specific monitoring devices (e.g., MRI compatibility for implanted devices) 1
• Skin sensitivity or allergy to adhesives (for patch monitors) 6
• Interference from other medications (e.g., acetaminophen with some glucose sensors, though Dexcom G6 is resistant up to 1g doses) 6

Clinical Safety Parameters

• Baseline ECG and QTc interval (especially for patients on QT-prolonging medications) 1
• Risk stratification for arrhythmias (determines monitoring intensity) 1, 9
• Hypoglycemia awareness status (impacts glucose monitoring strategy) 1

Education and Training Requirements

Initial Training Needs

• Device insertion/application technique (if applicable) 6
• Data interpretation skills (reading trends vs. individual values) 1, 6
• Troubleshooting common technical issues 7, 2
• When to seek immediate medical attention 1, 3

Ongoing Education

• Disease self-management education needs 1, 4
• Medication adjustment protocols based on monitoring data 1
• Lifestyle modification support (diet, exercise, sleep) 1
• Recognition of device malfunction signs 1, 5

Common Pitfalls to Avoid

• Never extend continuous glucose monitor wear beyond manufacturer specifications (Dexcom G6 must be replaced every 10 days) 6
• Do not rely solely on individual glucose values in dialysis patients; focus on patterns 6
• Avoid assuming older patients cannot use technology (age alone does not predict technology competency) 2
• Do not implement RPM without confirming adequate internet connectivity and device compatibility 1
• Never skip assessment of privacy concerns, especially for adolescents requiring confidential space 1
• Avoid one-size-fits-all alert thresholds; individualize based on patient baseline and comorbidities 1