Implementing Remote Patient Monitoring in an Integrated Trajectory of Care for Patients with Chronic Pain

Background: Remote patient monitoring (RPM) is a promising tool to support chronic pain (CP) management and improve outcomes through routine timely data transmission, enabling early symptom detection and intervention by healthcare providers. However, existing digital solutions have important limitations such as minimal end-user involvement in co-design, raising concerns about adoption and relevance. To address these gaps, a collaborative user-centred approach was used to (1) explore the needs of patients and their providers regarding healthcare delivery and self-management; (2) identify perceived benefits of using TM beyond clinical encounters; (3) codevelop an interactive patient-provider RPM prototype tailored to previously identified needs and (4) evaluate the implementation and preliminary efficacy of the platform. This presentation describes the perspective of a health system administrator, a patient and technology expert on the development approach, technology and preliminary evaluation.

Approach: Guided by user-centred design principles, we employed a multi-phased research approach to facilitate the identification of user needs and support the development of the RPM prototype. In Phase 1, semi-structured focus groups were conducted with a convenience sample of 6 patients and a purposive sample of 16 providers recruited from CP clinics to identify the perceived needs of users, RPM features supporting those needs, and perceived benefits of RPM. In Phase 2, purposive sampling was used to select 20 providers, 5 patients, and 7 content experts in the fields of eHealth and/or research or service delivery in CP. All participants were asked to use findings from Phase 1 to develop and iteratively modify an initial prototype through a series of virtual co-design sessions with the technology partner. Prior to full-scale evaluation and provincial deployment, we will be conducting a 4-month multi-method exploratory evaluation (early 2025) to uncover micro, meso and macro level factors that need to be considered in the planning, implementation and health system impacts phases of the project prior to full-scale evaluation.

Results: The iterative multi-phased user-centred design approach combined with ecological momentary assessment methodology, resulted in changes of the prototype to meet important user needs: 1) Pain impact; 2) Challenges in care delivery and CP management; 3) RPM priority features; and 5) RPM value proposition. Design principles (real-time information sharing, technological literacy, partnership, behavioural activation, capacity-building, actionable monitoring, and human connection) informed modifications to the prototype to ensure acceptability, usability, feasibility and meaningfulness. The prototype integrates symptom questionnaires to assess biopsychosocial domains, treatment adherence and self-efficacy; actionable clinical alerts; and tailored advice and education guided by rule-based algorithms. The results of the exploratory evaluation will highlight barriers/facilitators to adoption and preliminary impacts of RPM.

Implications: Developing, implementing and evaluating innovative technologies with end-users ensures a greater willingness to adopt new processes, behaviours and technologies. Tools developed using user-centred design resonate with patients, providers and health system administrators/policy-makers and enhance willingness to change processes and behaviours at the micro-, meso-, and macro-level to adopt innovative technologies. The exploratory evaluation will demonstrate impact at the patient, provider and system level while documenting optimal integration into workflows to support large-scale deployment across various levels of care.