William G. Dixon, MRCP, MSc, PhD, on Remote Monitoring of Rheumatoid Arthritis
People with rheumatoid arthritis (RA) often experience continual, daily symptoms that change over time. It can be challenging for a specialist to understand how RA symptoms will change between visits, especially after a single consultation.
For the Remote Monitoring of Rheumatoid Arthritis (REMORA) study, the researchers created the Remote Monitoring of RA smartphone app with patients and clinicians to determine the impact of daily patient-generated health data (PGHD) on clinical management and self-management of RA. The recorded PGHD were integrated into the electronic health record (EHR) of a single hospital and were available during consultations with patients.
Findings from REMORA indicated that the remote monitoring system identified real-time changes in disease activity, as well as created a person-centered approach to RA management, which allowed patients to better participate in consultations and treatment plans.
Consultant360 caught up with William G. Dixon, MRCP, MSc, PhD, director of the Centre for Epidemiology Versus Arthritis at the University of Manchester in Manchester, England, and coauthor of the study, about the research.
CONSULTANT360: What prompted you to conduct the study?
William Dixon: We wanted to design a system that would support the collection of regular PGHD for self-management, clinical care, and research. The Remote Monitoring of RA smartphone app was designed with this goal in mind, and we took the views of patients, clinicians, and researchers into consideration. The data from the app will be available for research, which will allow us to understand more about the rhythms of disease and have a more detailed appreciation for outcomes like response to treatment.
C360: What was the most important finding from the study?
WD: When we examined integrating PGHD into the EHR to support consultations with patients, there were a few key findings. From the patient perspective, the remote monitoring data led them to feel like the consultations became more personal, they benefitted from the discussions that were based on their own data rather than from questions the doctor directed, and that “the data said it for them.” From the clinician perspective, the remote monitoring data provided a clearer picture of symptoms and led to changes in treatment. For example, the data showed how symptoms that were otherwise forgotten were available through the real-time capture. Also, we were able to see long-term trends that were otherwise hidden in the day-to-day volatility of symptoms.
C360: How do you think remote monitoring of RA can impact clinical practice?
WD: Having a clearer picture of day-by-day changes in symptoms, visualized over months, allows more informed decisions in clinical practice. The graphical summaries from the data available during the consultations also served as important visual aids that supported more informed shared decision-making. Treatment decisions are made at short clinic visits every few months, so remembering previous symptoms can be difficult. One solution would be for people with RA to record daily information about their health at home. This could be sent to their health care team to try to improve decisions about care. Modern technology, such as smartphones, could provide a simple but powerful way to collect and share this information.
C360: What are the next steps of your research?
WD: We are currently working to establish an end-to-end system and associated infrastructure that allows remote monitoring to be scalable for any health care system. This requires its integration into a time-limited consultation, with the ability for patients to set up an app at home and for the tracked symptom data to be stored in an appropriate repository where it can interoperate with any EHR system. We will also further evaluate the benefits of remote monitoring for clinical care and research in a wider range of settings beyond the early adopters.
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Austin L, Sharp CA, van der Veer SN, et al. Providing ‘the bigger picture’: benefits and feasibility of integrating remote monitoring from smartphones into the electronic health record: findings from the Remote Monitoring of Rheumatoid Arthritis (REMORA) study [published online July 23, 2019]. Rheumatology. doi:10.1093/rheumatology/kez207.