Remote Patient Monitoring After the Pandemic: Who Benefits?
During COVID-19, remote patient monitoring went from a nice-to-have to a baseline expectation. Health systems bought pulse oximeters and blood pressure cuffs by the thousands. They built dashboards, hired coordinators, and signed contracts with platform vendors who promised to keep patients out of hospital beds. The crisis justified the speed. Now that the crisis has passed, the question is whether any of it stuck, and who actually came out ahead.
The Numbers Look Good on Paper
RPM adoption in Canada roughly tripled between 2020 and 2024. The Canadian Institute for Health Information reported that over 400 health organizations had active RPM programs by mid-2024, up from around 130 pre-pandemic. Most of these programs target chronic disease management: congestive heart failure, COPD, Type 2 diabetes. The clinical rationale is sound. If you can catch a fluid overload or a blood glucose trend before the patient shows up in the emergency department, you save the patient a hospital stay and the system a significant cost.
The retention numbers tell a different story. A 2024 review of 18 Canadian RPM programs found that roughly half of enrolled patients stopped transmitting data within six months. The reasons varied. Some patients found the devices cumbersome. Others had unreliable internet access. A significant number simply forgot, or stopped seeing the point when nobody called them back about their readings.
The Access Question
RPM works best for patients who have a stable home environment, reasonable digital literacy, and reliable broadband. That describes a specific demographic. It does not describe many of the patients who would benefit most from continuous monitoring.
Rural communities face obvious connectivity challenges. Northern and remote Indigenous communities in Canada often lack the bandwidth for consistent data transmission. Elderly patients living alone may struggle with Bluetooth pairing or app-based interfaces. Low-income households may not have a smartphone capable of running the required software.
This creates a paradox. The patients most likely to be hospitalized for preventable deterioration are the same patients least likely to succeed in a standard RPM program. The technology works. The implementation model, built around the assumption of a connected and capable patient, does not account for social determinants of health.
What We Measured and What We Missed
Most RPM evaluations focus on clinical outcomes: hospitalization rates, emergency department visits, time to intervention. These are important metrics. They are also incomplete.
What gets measured less often is the patient experience of being monitored. Several qualitative studies have found that patients describe RPM as reassuring in the first few weeks, then increasingly burdensome. The obligation to take daily readings can feel like homework. When readings are normal for weeks at a time, the exercise starts to feel pointless. When readings are abnormal, patients report anxiety about what will happen next, particularly if the response from their care team is slow or unclear.
There is also the question of clinical workflow. RPM generates data. That data needs to be reviewed by someone. In programs where a dedicated nurse or coordinator triages incoming readings, the system works reasonably well. In programs where RPM data flows into a general inbox alongside lab results and referral letters, it often gets lost. The monitoring happens, but the response does not.
What Would Need to Change
RPM programs that work tend to share a few features. They have dedicated staff reviewing data daily. They contact patients proactively, not just when a threshold is crossed. They design the enrollment process around the patient's living situation, not around the device specifications. And they measure retention as seriously as they measure clinical outcomes.
The technology itself is not the problem. The problem is that most RPM programs were designed around the device, not around the patient. Fixing that requires investment in human infrastructure: coordinators, outreach workers, technical support for patients who need it. It also requires honesty about who these programs currently serve and who they leave out.
Remote monitoring has genuine clinical value. The question is whether we're willing to build programs that deliver that value equitably, or whether we'll settle for serving the patients who were easiest to reach in the first place.