Table 1.

Overview of problems and challenges of remote patient monitoring (RPM) interventions for clinical staff.

Theme and description		Studies
Planning and implementation
	Lack of previous user testing	Harsha et al [21]
	Lack of planning or inadequate planning Lack of contemplation of changes in workflow (tasks, competences, responsibilities, and roles) Emergence of uncontemplated tasks No standardization in practices and no clear guidelines Noncompatibility with current practices No clear definition of time for tasks No long-term care coordination Services are implemented before all the resources are available and prepared	Das et al [22] Davoody and Hägglund [23] Harsha et al [21] Ke et al [24] Leppla et al [25] Sanger et al [26] Timmerman et al [27] Wiadji et al [28]
	Lack of resource analysis (“readiness level”) No clear overview of required skills No consideration of staff experience No clarity on resource accessibility (whether clinical staff is adequately equipped)	Ke et al [24] Parkes et al [29] Rothgangel et al [30] Wiadji et al [28]
	Lack of multidisciplinary awareness Uncontemplated users, nonusers, and other actors affected Limited or poor communication and coordination among users Poor task planning (tasks overlapping and no consideration for the need of staff to attend to 1 patient at a time) Disregard for the specificities of different specialties and wards (eg, cardiovascular and pediatric)	Harsha et al [21] Leppla et al [25] Makhni et al [31] Parkes et al [29] Wiadji et al [28]
	Lack of compliance and engagement Lack of involvement of stakeholders in planning Fear of conflict of interest Lack of promotion and motivation among staff Decrease of use of systems over time Resistance to change Specialists and rural hospitals, among others, feeling threatened to be replaced	Downey et al [32] Harsha et al [21] McMullen et al [33] Parkes et al [29] Rothgangel et al [30] Sharif et al [34] Timmerman et al [27] Wiadji et al [28]
Workload and logistics
	High workload New tasks as an addition and not a replacement Telehealth tasks are perceived to be labor-intensive (“More administrative work in arranging telehealth than meets the eyes”) Tracking patients takes too much time (because of subtasks such as setting up appointments, billing, mailing, analyzing, reviewing transmissions, documenting in the EMRa, and physician contact) Remote patients are not considered as part of “normal flow” (ignored for workload calculation) Potentially adding an unnecessary step when patient attention is needed (immediate patient check by GPb instead of data follow-up by nurse) Documentation is burdensome	Brophy [35] Das et al [22] Dunphy et al [36] Harsha et al [21] Ke et al [24] Leppla et al [25] Makhni et al [31] McMullen et al [33] Parkes et al [29] Sharif et al [34] Wiadji et al [28]
	Disruption in workflow Unpredictable, emergent tasks High memory load Mistakes on interrupted activities Unanswered or unplanned calls	Das et al [22] Downey et al [32] Harsha et al [21] Sanger et al [26]
	Nonurgent tasks emerge outside working hours	Ke et al [24]
	Need of trustworthy professionals for data analysis Nurses sometimes need to consult with physicians	Leppla et al [25]
	Fear of infringing on other providers’ patient care	Brophy [35]
	Stress because of pressure for timely responses to multiple issues	Das et al [22] McMullen et al [33] Parkes et al [29]
Technology
	Difficulties in use of e-tools Not user-friendly No experience or training	Brophy [35] Das et al [22] Davoody and Hägglund [23] Parkes et al [29] Rothgangel et al [30] Sousa et al [37] Timmerman et al [27]
	Technical problems Troubleshooting and malfunctions Connection issues (eg, congestion, no signal, and delays) Not compatible with current software	Augestad et al [38] Brophy [35] Harsha et al [21] Makhni et al [31] Timmerman et al [27]
	Deficient communication Inappropriate means of communication Hard to establish “personal connection” for communicating bad news or managing conflict with patients New medical-legal situations (patients might misunderstand information or take it out of context) RPM interventions might not be suitable to all the patients	Augestad et al [38] Dunphy et al [36] Ke et al [24] Leppla et al [25] Makhni et al [31] Parkes et al [29] Wiadji et al [28]
	RPM does not offer monitoring to the same extent as in-hospital monitoring No physical examination Cannot assess if patient does self-monitoring or prescribe activities correctly	Dunphy et al [36] Ke et al [24]
Data
	False or insignificant alarms or overreaction Stress by constant sound Turning devices off or not using them	Downey et al [32] Harsha et al [21] Richards et al [39]
	Unclear data and meaning Require extensive analysis Overabundance of data No flag data Missing connection among data	Das et al [22] Leppla et al [25] Sharif et al [34]
	No clear “holistic” impression of patients Lack of data integration with EMR and other existing platforms Not all the reports generated by the system are consulted by physicians	Das et al [22] Semple et al [40] Sharif et al [34] Timmerman et al [27]
	Low reliability of patient monitoring Incomplete data Incorrect measurements	Leppla et al [25] Sharif et al [34]
	Legal issues (eg, privacy, firewall, and licenses)	Brophy [35] Das et al [22] Ke et al [24] Makhni et al [31] Semple et al [40]
Health care resources
	Lack of funding Higher costs than budget Nonsustainable billing rates No clinic income established Higher payment for in-hospital visits	Das et al [22] Brophy [35] Harsha et al [21] Makhni et al [31] Wiadji et al [28]
	Demand of new or more resources	Das et al [22] Makhni et al [31]
	Difficult to quantify quality and effort	Wiadji et al [28]
	Unclear compensation or reimbursement policies Telehealth can take up the same amount of time for significantly less remuneration	Brophy [35] Ke et al [24] Semple et al [40]

^aEMR: electronic medical record.

^bGP: general practitioner.