Table 3 Summary of evidence (findings and implications)

Position

The majority of RPMTSs are deployed in post-hospital settings to monitor chronic conditions, previously diagnosed within hospitals. Few RPMTSs are deployed in pre-clinical settings for preventive, prognostic or diagnostic purposes.

While the increasing prevalence of chronic diseases in ageing populations is the main driver for the rapidly increasing use of RPMTSs, deploying RPMTSs in remote, automated prognosis, preliminary diagnosis and prescheduling of visits to healthcare facilitates have significant potential for the prevention and early detection of above diseases and therefore ought to receive adequate research attention.

Levels of integration

RPMTSs deployed in post-hospital settings are generally integrated into existing clinical workflows. However, RPMTSs deployed in pre-hospital and primary care settings are often not integrated into existing clinical workflows (e.g. quantified-self apps).

RPMTSs can only help reduce the care burden on traditional healthcare systems when they are linked to them. There is therefore a need to consider integration into existing clinical workflows as a key requirement when designing RPMTSs for deployment in pre-clinical and primary care settings.

Functional versatility

While RPMTSs used in the management of chronic diseases are mostly targeted at a single disease and its related symptoms and vital signs, the few RPMTSs found in pre-clinical settings are generally versatile and tend to focus on a combination of potential diseases.

Addressing multiple diseases with a single RPMTS intervention might improve its likelihood for adoption and potential for scaling. There is a need for increased built-in, interpretive capacity to avoid expecting untrained users to make sense of resultant information on their own, without the necessary skills to do so (automatic interpretation of medical data is critical).

Accessibility

Accessibility is generally limited: Interventions in the preclinical and primary care settings are severely hampered by the lack of legal frameworks as well as issues related to information privacy and security and those in post-hospital settings for the monitoring of chronic conditions generally focus on a single disease, thereby limiting the number of potential adopters.

In post-hospital settings, the focus on a single disease means that only patients who suffer from the targeted disease can be addressed, thus limiting the scope for adoption and scaling. For RPMTSs contemplated for pre-clinical settings, there is a need to work with policy-makers to develop a legal framework and policies not only to address ethical and safety issues but also those related to information privacy and security.

Main intervention’s purpose

Healthcare organizations are mainly driven to utilize RPMTSs to manage the increasing care burden resulting from the rapid rise in chronic conditions. They are mainly used in an attempt to reduce the resulting skyrocketing care costs around the world. Improved care quality is also often targeted

The end-goal is not management but cost and workload reduction. Prevention could be less costly than treatment. By using RPMTSs to boost disease prevention and early detection, some diseases might be entirely avoided and the costs of managing chronic conditions might be significantly reduced.

Main design approach

The benefits of a user-centred or patient-centric design approach are widely acknowledged to promote adoption and scaling. However, in less than half of RPMTSs’ design cases, a user-centred or patient-centric approach is pursued and appropriate methods of involving users in RPMTS’s lifecycle phases are still in their infancy.

Involvement of users in the conceptualization, design and deployment of a new RPMTS is a key driver for its subsequent adoption, scaling and sustainability. Therefore, designers interested in the adoption and scaling of their RPMTSs ought to find a systematic way or method of allowing users to shape the design and deployment of their contemplated RPMTSs.